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UNITED STATES OF AMERICA. 



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Mother, Nurse md Infrnt 



A MANUAL 

ESPECIALLY ADAPTED FOR THE GUIDANCE OF 
MOTHERS AND MONTHLY NURSES, 

COMPRISING FULL INSTRUCTION IN REGARD TO 

Pregnane^, .Preparation for 6hild=Birf;h, 

AND 

The ©are of JEoftier and ©hild, 



AND DESIGNED TO IMPART SO MUCH KNOWLEDGE OF ANATOMY, 

PHYSIOLOGY, MIDWIFERY, AND THE PROPER USE OF 

MEDICINES AS W T ILL SERVE INTELLIGENTLY 

TO DIRECT THE WIFE, MOTHER AND 

NURSE IN ALL EMERGENCIES. 



* 



By S. P. SACKETT, M. D. 



NEW YORK : 

H. CAMPBELL CO., Publisher! 
140-142 Nassau St. 
1889. 




c^ 



Copyrighted, 1889, 

— by — 
S. P. SACKETT. 

All rights reserved. 



PRESS OF E. D. NORTON, 
ITHACA, N. Y. 



PREFACE. 



The object of the author in writing this volume is to 
offer to nurses, and especially to those women who desire 
to make "monthly nursing" a vocation, the instruction 
which they need for that purpose, sufficiently illustrated 
and at a moderate price. 

The book is written under a firm conviction in the 
mind of the author that a work of this character is needed 
at the present time — a work that combines some informa- 
tion to the monthly nurse in regard to her peculiar duties 
* with considerable instruction in midwifery. He has 
many times heard inquiries made for a book of this kind 
and has not been able to point to one of the character 
desired. He has learned during the forty-five years that 
he has practiced medicine in a small city and its vicinity, 
that mother and nurse are often combined in the same 
person. The important duty of nursing the sick is so 
generally performed by mothers, that they also, as a class, 
require some scientific knowledge to be acquired by 
means of plain, practical instruction. And, in fact, 
throughout our country, every mother is liable, in an 
emergency, to be called upon to fill the office of an 
accoucheur. 

For the professional nurse, such technical and accurate 
knowledge should be considered indispensable. The 
training schools for nurses in some of our largest cities 
are doing a noble work, and are elevating the standard of 
requirements for those who seek this field of true woman- 



iv Preface. 

ly labor. But comparatively few of the many thousands 
who follow this vocation are able to attend such schools ; 
yet they are willing and desirous to learn. Women seem 
instinctively to desire such knowledge. A proper effort 
to place within their reach the means of obtaining the 
necessary technical knowledge for their work, and espec- 
ially for the work of the nurse who attends upon the 
mother in child-birth, will not, the author trusts, be 
deemed presumptuous. There are many excellent nurses, 
who have become so without the aid of training school or 
such a book as this, but it is hoped that this volume may 
make the acquirement of the necessary knowledge more 
easy and furnish ready information of value to those 
nurses who are most thoroughly perfected in their work. 
Physicians, they will find, stand ready to aid them. The 
attending physician, as a rule, may be depended upon to 
give such help as may be necessary to the understanding 
of the instructions here presented, and through their co- 
operation the number of earnest students in this depart- 
ment of womanly labor may be multiplied. 

The author, during the preparation of it, consulted 
many writers upon obstetrics, medicine and nursing ; 
and it is only because it would not be compatible with 
the size of this volume, that he has not made frequent 
references to these excellent works. But all that he has 
written has been founded on his own knowledge, experi- 
ence, and observation, while it coincides with the ex- 
pressed opinions of others who may be considered good 
authority. In only two or three things has the author 
ventured to advance beyond others. 

S. P. S. 

Ithaca, March, 1889. 



CONTENTS. 



Introduction 9 

PART I. 

PREGNANCY AND CONFINEMENT. 

Chapter I. 
Conduct of the Mother before and after Marriage 13 

Chapter II. 
Conduct of the Mother during Pregnancy 18 

Chapter III. 
Diseases of Pregnancy 22 

Chapter IV. 
Instructions to a Woman during the last stages of Gestation . . 26 

Chapter V. 
Directions to the Monthly Nurse 33 

Chapter VI. 
Care of the Mother during Labor and Confinement 36 

Chapter VII. 
Directions to the Nurse during the month « 43 



vi Contents. 

PART II. 

ANATOMY AND PHYSIOLOGY OF THE FEMALE ORGANS — FCETAL 
DEVELOPMENT. 

Chapter I. 
Of the Pelvis 55 

Chapter II. 
Parts contained in the Pelvis 64 

Chapter III. 
Physiology of the Uterus and Ovaries 70 

Chapter IV. 
Displacements of the Uterus 76 

Chapter V. 
Mismenstruation 87 

Chapter VI. 
Generation 93 

Chapter VII. 
The Ovum and its development 08 

Chapter VIII. 
The Foetus 103 

PART III. 

PREGNANCY AND PARTURITION. 

Chapter I. 
Diagnosis of Pregnancy 113 

Chapter II. 
Abortion 119 

Chapter III. 
Parturition 123 

Chapter IV. 
Mechanical Phenomena of Labor 132 

Chapter V. 
Diagnosis of Artificial Labor 137 



Contents. vii 

PART IV. 

SKILLED NURSING AND MIDWIFERY. 

Chapter I. 
Preliminary instruction to the Nurse Midwife 145 

Chapter II. 
The Natural Labor 149 

Chapter III. 
Convalescence 163 

Chapter IV. 

Care of Infants 170 

* Chapter V. 
Cases of Difficult Labor 177 

Chapter VI. 
Coiicludinginstructions in Midwifery 192 

PART V. 

^ETIOLOGY — SYMPTOMATOLOGY — MEDICATION — NURSING. 

Chapter I. 
Causes of Disease 196 

Chapter II. 
Symptoms of Disease 203 

Chapter III. 
Diagnosis of Diseases of Children 217 

Chapter IV. 
Treatment of Inflammation in its initial stages 223 

Chapter V. 
Various circumstances, Contagion, Death, &c 231 

Chapter VI. 
Surgical Nursing 251 



viii Contents. 

PART VI. 

REMEDIES AND REGIMEN. 

Chapter I. 

Hints in regard to the treatment of Common Diseases 262 

Chapter II. 

Emergencies, Accidents, Sudden Sickness 279 

Chapter III. 

Slight Hurts and Ailments 295 

Chapter IV. 

Dietetics, Food for Children 307 

Chapter V. * 

Prescribing and Prescriptions 327 

Medical Formulary 333 

Glossary 364 

Index 379 



INTRODUCTION. 



From the nature of the subjects treated in this work, 
the information given becomes of interest to every woman, 
and is not intended for the nurse of lying-in women only. 
It is believed that many young women will study it care- 
fully, that they may be prepared for all the duties and 
responsibilities of life ; some, perhaps, that they may be 
fitted for a vocation under certain contingencies. But 
many of the instructions are addressed particularly to 
mothers, because they especially will be able to make a 
practical application of the knowledge received. Hence 
considerable matter is inserted which is designed to be 
used by mothers in their daily life, and having only a 
slight bearing on monthly nursing. Necessarily, as the 
two objects are combined to suit the wants both of the 
mother and nurse, there is not as much order and system 
in the topics presented as would otherwise be desirable. 
I seek only to have my instructions in the form that will 
be most useful, and I believe that if mothers at the pres- 
ent time are sufficiently taught there will be no lack, a 
few years hence, of nurses who are fully competent to 
care for the sick, under the direction of competent physi- 
cian. Hence I address myself, first, 



io Introduction. 

TO THE MOTHER. 

To those who are mothers, every part of this small book 
is especially commended. Upon the knowledge and skill 
and right action of those who have the care of children 
and of the household, it will depend that the right thing 
shall be done in such emergencies as are liable to occur. 
You must necessarily care for your children, both to guard 
them from sickness and to relieve their ailments. You 
must know the symptoms, at least, how to observe the 
symptoms, of diseases ; and you may be called upon, in 
the absence of the physician, to act as midwife. Be espe- 
cially careful to learn the instructions in regard to emer- 
gencies, because upon your knowledge and prompt action 
the lives of your dear ones may depend. 

TO THE PROFESSIONAL NURSE. 

This work is written for you, and to you is especially 
commended the modicum of medical knowledge herein 
contained. It is better for you to learn well what you 
read than it is to read very extensively. You will find 
sufficient in this small volume to demand your time and 
study for months, and even for years, in connection with 
your nursing. It is not expected that you will learn all 
the formulae and prescriptions given. These are inserted 
partly that you may learn to read prescriptions in the 
various forms in which they are written, and partly that 
you may occasionally use one, after consulting with your 
physician. Sometimes you may copy one of them accu- 



Introduction. ti 

rately and use it at the drug store, consulting only with 
the apothecary. 

But it will be of importance to you to obtain as much 
medical knowledge as is herein contained, though it is not 
designed to make you physicians. Do not act the part of 
a doctor until you understand every thing pertaining to 
Anatomy and Physiology, and the nature and properties 
of every medicine employed in the cure of disease. Of 
all sciences the medical should embrace the widest domain 
of knowledge, because ignorance here is fatal. But ignor- 
ance and thoughtlessness, and want of skill and adapta- 
tion, may be fatal in your particular province. The 
physician will generally tell you that the recovery of his 
patient depends as much upon faithfulness and skill and 
care on your part as upon his own medicines. Seek 
always to aid him, never to supercede him. If you learn 
midwifery, it should be with the design of co-operating 
with the doctor, and assisting him. You should be so 
educated that the physician will feel willing to leave a 
case of tedious labor in your care, instead of waiting at 
the bedside of the patient one or two days, and neglect- 
ing his other patients. Your educated service will be ap- 
preciated at such times by the doctor, as well as by the 
patient and her friends. You will do the duties of nurs- 
ing well, and take upon yourself that part of the practice 
of a physician which he does not desire, and which you 
can do equally well. Your part will be an important one, 
and second only to that of the physician. 



12 Introduction. 

I expect, as the result of the study of this book, not that 
you will assume to be physicians to any greater extent 
than you otherwise would, but that you will act wisely 
and intelligently instead of confusedly, or blindly, in the 
emergencies in which you will be called upon to act, — 
that you will be, not merely attendants at the bedside of 
the sick, but, that best aid to the physician, the true nurse. 

Do not claim to be doctor or midwife, or anything 
whatever that you are not. If a smattering of knowledge 
causes any affectation, it will only degrade you. Study 
physiology in the books commonly used ; store your 
minds with the facts and instructions in this book; ob- 
tain additional knowledge in every way that is practica- 
ble. As you have opportunity, make practical application 
of the knowledge received, and you will commend your- 
self more and more to your sick or suffering friends. 



PAl^T I. 
PREGNANCY AND CONFINEMENT. 



CHAPTER I. 

CONDUCT OF THE MOTHER BEFORE AND AFTER MARRIAGE. 

The physical treatment of children should begin, as far 
as may be practicable, with the earliest formation of the 
embryo. It will involve the conduct of the female even 
before her marriage, as well as during her pregnancy — 
the various contingencies which effect her in health as 
well as in disease. Very much depends on her to insure 
for her child a vigorous constitution, or to prevent a feeble 
frame in the child. She should not enter into the holy 
state of marriage with heedless haste ; if she does, she 
will discharge its duties with inexcusable neglect. To 
constitute a mother, in the best sense of the term, requires 
a patient endurance of fatigue, and anxious solicitude, 
which will sorely tax the mother's strength. I would, if 
possible, diminish the toil and danger of childbirth, and 
relieve the fatigue and anxiety of nursing. 

And let me, in one paragraph, give a hint to the hus- 
band : that the responsibility and care of the children is 
too much laid on the mother ; she is overburdened. Let 
the father partake in the arduous and responsible duty of 



14 Mother, Nurse and Infant. 

their education. And let me hint, also, that the health 
and strength of the child depends upon the father as well 
as the mother. 

Marriage should not be at too Early a Period 
of Life. — I am not disposed to discourage early marriage, 
but I am decidedly opposed to a premature one. Mar- 
riage should not take place until the body is healthily and 
completely developed ; to bear offspring prematurely en- 
dangers not only the mother's health, but it materially 
influences the health and well-being of the child. 

We cannot fix rigorously the age at which the body be- 
comes fully expanded. I am inclined to say it is at 20 in 
the female, and at 24 in the male ; but original stamina, 
education, climate, mode of life, etc., have their influ- 
ence, and may make an earlier or a later marriage proper. 

The evil- consequences resulting from precocious unions 
in this country are : diminished vigor and shortened life 
in the husband ; faded beauty, blasted health, and prema- 
ture old age in the mother, and a diminutive stature, de- 
bility of body and imbecility of mind, perhaps a strong 
predisposition to consumption, rickets, scrofula, etc., in 
the children. 

Marriage should be when the Parties are in 
Health. — I do not say that every ailment should be a 
bar to marriage or child-bearing. It is possible that pro- 
lapsis uteri may be benefited by a pregnancy and parturi- 
tion. But if a woman has prolapsis uteri, or other ail- 
ment, it is a poor preparation for the burdens of gestation, 
and good health is an important qualification for the re- 
sponsibilities of married life. No learning can be of more 
importance to a young lady than to know how to preserve 
health, and how to restore it when lost, for we cannot 
reasonably expect healthy children from unhealthy par- 



Pregnancy. 15 

ents. There are numerous other complaints besides 
scrofula and insanity, inherited by children. If a wife is 
to be healthy and strong, she must use means ; health will 
not come by wishing for it merely, and whether pleasant 
at first or not, habit will make early rising, temperate liv- 
ing, taking exercise, thorough ablution of the whole body, 
etc., easy. That state of vigorous health and strength 
which prepares a woman to bear strong and vigorous 
children, is attained not by idleness and luxury, and neg- 
lect of personal cleanliness, nor by tight lacing, the use 
of stimulants, nor by irregular modes of sleeping, etc., 
but by rising early, and taking early walks in the open air, 
and engaging in household labor, or other exercise during 
the day, going to bed betimes, living on an abundance of 
good, wholesome food, by daily ablutions, followed by rub- 
bing the skin thoroughly, and in general by observing the 
laws of health. If a woman who has thus preserved her 
health, marry a man who has been equally careful to ob- 
serve the laws of continence and hygiene, she may hope 
to be the mother of a healthy child, and a blessing to all. 

The Constitution of both the Male and Female 
should be good and strong. It is not enough that the 
body be well developed, if there is at the same time a very 
feeble constitution. Even if the children of such parents 
seem to be hale looking and robust, they do not attain old 
age — are very liable to die young. If there is only a pre- 
disposition to disease, such as is often inherited, it may be 
very doubtful whether the parties ought to marry. If 
there is only a disposition to habits of intoxication or dis- 
sipation, or to gout, madness, scrofula, consumption, etc., 
in the man, we may advise the woman not to unite herself 
to him, for these diseases do not show themselves until 
called into action by some exciting cause. 



16 Mother, Nurse and Infant. 

But we advise the woman, if there is any physical disa- 
bility which renders her ineligible to the married state, 
that she should not pass it over lightly, or conceal it, and 
we would recommend to a woman who may have deformed 
pelvis, that she abstain from marriage, as she "may pur- 
chase the title of wife at too dear a price." 

Temperament is a matter of less importance in choos- 
ing a husband. It is said to be the case that in choosing 
a mate, a person inclines strongly to one unlike themselves. 
If it be true that a person of a nervous temperament has 
a preference for the sympathetic, the sanguine for the bil- 
ious, etc., it is probably nature imparts the liking that the 
offspring may combine the excellence of both, the defects 
of neither. 

Blood relationship is not necessarily a bar to union. 
Cousins may marry when the family has traits of mental 
and physical excellence as a means of perpetuating them, 
but it is not best to develope, by repeated unions, a lurk- 
ing disposition to disease, which may exist in any family. 

Moral and mental character is of the greatest im- 
portance. It is not true that " the reformed rake makes 
the best husband." If he is not the prey of loathsome 
diseases, the results of a vicious life, his constitution is 
probably impaired, so that he cannot be the father of good, 
strong children. The only way that women can guard 
their own health, and preserve from degeneracy their off- 
spring, is by having husbands of a different character from 
that of the debauched rake. 

CONDUCT OF THE MOTHER AFTER MARRIAGE. 

The mother is accountable for the health and intelli- 
gence of her first child ; she must be careful of her own 
health before marriage and at the time of marriage, as 
well as for the succeeding time. 



Pregnancy. 17 

I will here state a few things which seem unimportant, 
and yet are of some little consequence. I consider that 
the great object of conjugal union is the transmission of 
life, and I cannot believe that anything is unnecessary or 
unimportant that has a tendency towards the perfect health 
or well-being of the child that is yet to be born. 

During the first few months after marriage the 
wife should seek to have bodily quiet, and mental calm- 
ness and serenity. The custom of hurrying the bride 
from place to place may properly be condemned. So we 
would have her avoid going into a whirl of excitement and 
pleasure — into a round of visiting and late hours — into 
close, heated rooms — into fashionable amusements — rich 
living and a want of rest — sitting in ill-ventilated apart- 
ments — quickly bolting unquiet meals — drinking wine, 
beer, or brandy, or other alcoholic stimulants — late rising 
in the morning — sleeping in close, badly-ventilated rooms 
— living in rooms that are kept dark — tight lacing — wear- 
ing thin clothing — worrying, and indulging in ill-temper. 

She should avoid these- at all times, but her future health 
and happiness depend so much upon her prudence and 
care during the first year of married life, that we may prop- 
erly give these hints and cautions in regard to this partic- 
ular time. 



CHAPTER II. 

CONDUCT OF THE MOTHER DURING PREGNANCY. 

There are no signs of a fruitful conjugation, which in 
all cases indicate to the woman that she is pregnant. 
Some few seem to know the exact time ; in some instances 
there is faintness, or vertigo, that in these particular cases 
impress the fact upon the mind of the woman. But usu- 
ally, within a month, the point is tolerably certain, she be- 
ing assured by such signs as will be here pointed out. It 
now becomes her duty to be especially careful, not only 
for herself, but also for her offspring. Abortions frequent- 
lly occur, especially in the first and last pregnancies, and 
in the first months of pregnancy, these should be avoid- 
ed if possible. 

The train of evils which follow when the habit of abor- 
tion is established, as well as the moral obligation she is 
under to preserve the life committed to her, should make 
her willing to endure the few privations and conformities 
which her situation imposes on her. She must avoid un- 
due exercise of the muscles, such as long walks, dancing 
in hot weather, hastily running up stairs, lifting heavy 
weights ; she must avoid things that inordinately hurry 
the circulation, such as heated rooms, stimulating liquors, 
etc. ; she must not overload the stomach, or eat late sup- 
pers ; she must not take drastic purgatives ; must not con- 
stipate her bowels by taking laudanum, etc. ; must not 



Pregnancy. 19 

compress the chest by tight lacing ; must not use strong 

tea or narcotics ; must not lie long in warm feather beds, 
and must not engage in severe study, night watching, etc. 

The pregnant woman need not indulge in a wayward or 
voracious appetite, and, although there is a tendency to 
fullness and fever, she need not necessarily be bled. 

The pregnant woman needs fully as much food as usual, 
but she must avoid excess in eating and drinking. Ripe 
fruits, lamb, veal, fresh fish, milk, coffee, and, in general, 
every thing which agrees with the stomach may be eaten ; 
the taste, as a rule, is a safe guide, and may be reasonably 
indulged. After the sixth month, she may properly eat 
four or five meals a day. 

The best plan of treatment for one to adopt who has 
longings is not to give way to them, unless the longings be 
of a harmless, simple nature. 

The clothing of the pregnant woman should be suited 
to the season ; but as the vicissitudes of the weather affect 
her more than they previously did, she should be dressed 
rather warm. In general, she should wear flannel drawers, 
especially during advanced pregnancy. 

Many women have done themselves an injury by lacing 
tight to conceal their pregnancy. The dress should be 
loose and comfortable, nowhere pressing tightly or un- 
equally. 

Stays or corsets may be used, in a proper manner, dur- 
ing the first five or six months ; they should be moulded 
to the shape of the changing figure, and must not depress 
the nipple or the enlarging breasts. The garters ought to 
be worn slack ; tight garters are very injurious, and if the 
veins are enlarged or varicose, it will be necessary for her 
to wear an elastic silk stocking. 

Moderate exercise in the open air is proper during the 



2o Mother, Nurse and Infant. 

period of pregnancy, and walking is a good kind of exer- 
cise ; but very long walks, and dancing, ought not to be 
indulged in. Riding in a wagon over rough roads, and 
railway traveling, are objectionable. 

Bathing should be practiced with great care. A warm 
bath is too relaxing ; a tepid bath once a week is bene- 
ficial. Sponging the body every morning with lukewarm 
water may be practiced, and the skin should be quickly 
dried with a coarse towel. The temperature of the water 
may be reduced gradually until it is quite cold. A sitz 
bath may be used every morning, although it is best to sit 
in it but a few seconds. If it gives a slight shock, it will 
be immediately followed by an agreeable glow. Put a 
little warm water with the cold at first. 

Ventilation is of the utmost importance. During the 
day time, the windows in every unoccupied room in the 
house ought to be thrown open. 

Attention should be directed to keeping the atmosphere 
in the sitting and sleeping rooms of the house fresh. Many 
poor people sleep in a very small, close bedroom, and 
breathe an air that is really poisonous. The lady should 
see also that the house is kept light, that the drains are in 
good and perfect order ; that the privies are frequently 
emptied of their contents, and that the drinking water 
supply be not contaminated. 

Sleep, by its sedative influence, and by the calmness of 
all the functions that attend it, has a favorable influence 
upon the disturbed nervous system of the mother, and 
upon the growth of the foetus. Her bedroom out to be 
large and airy, and she should not have curtains closely 
drawn about her bed. The windows of the room should 
be opened during the day ; the bedclothes should be thrown 
back, and everything ventilated ; the bed must not be 



Pregnancy. 21 

loaded with clothes, and the bedroom at night should be 
dark, and as far as possible from noise. These things 
will tend to secure sleep ; but if the pregnant woman 
should still be restless, and feeling oppressed and hot, she 
should perhaps admit more air into the room. Let her 
also attend every day to her bowels, that they be not 
allowed to become costive ; perhaps eat cooling fruits, live 
on an abstemious diet, and if there is a feeling of faint- 
ness when she attempts to lie down, she should have a bed 
so arranged that her shoulders and head are elevated. 

The pregnant woman ought to retire early to rest, and 
I would advise her to lie abed in the morning as long as 
she can sleep well. If she cannot sleep well, let her get 
up in good time in the morning, take a bath, or thorough 
ablution, a stroll in the garden, an early breakfast, and 
then perhaps a short walk, while the air is cool and exhil- 
erating. A nap of an hour or two after that, upon a sofa 
or lounge, will prove very refreshing. 

A tranquil mind is of the greatest importance. Fore- 
bodings of a gloomy nature should not be encouraged, as 
they often are, by relating dismal stories, etc. Unneces- 
sary fear upon the part of the mother may have a bad 
effect upon the child, as may also the indulgence in un- 
bridled anger, or yielding to temper, — perhaps may cause 
convulsions or hemorrhage, or even abortion. There is 
reason to believe that the imagination of the mother has 
an influence on the beauty of the child ; and it is quite 
certain that cheerfulness and equanimity of mind contrib- 
utes to the future good health of the child, and may even 
affect its disposition and mental traits. 



CHAPTER III. 



DISEASES OF PREGNANCY. 



Pregnancy is not a disease. Many women enjoy better 
health during its continuance than any other time, and in 
general the pregnant woman is not quite as much exposed 
to contagious and other diseases. But there are certain 
disorders incident to pregnancy, of which it is necessary 
to speak. 

Morning sickness, when it is only troublesome during 
the early part of the day, is generally borne without much 
complaint, or much medical care. Before taking any 
medicine for it, I advise that the lady try such simple 
means as the following : Let her take a cup of coffee or 
milk, and eat a few crackers or a biscuit, after washing 
her hands and face, and before rising in the morning ; 
then let her remain in bed for about fifteen minutes, then 
dress quickly and take a short walk. If the sickness con- 
tinues, let her eat freely of pop corn, and she may eat of 
this occasionally during the day, or whenever she is suf- 
fering from sickness, and let her partake of other food 
also during the day. Persistent sickness and vomiting 
indicates a disordered condition of the digestive apparatus, 
and requires appropriate remedies. Use successively the 
following: Formula 85, 104, 139, 140. 

Vomiting is sometimes so persistent and severe that 
the stomach can retain nothing, or but very little food. 



Pregnancy. 23 

Of course', such cases demand the aid of a physician, and 

his efforts to give relief may be effectual, when the medi- 
cine here directed fails. 

Costiveness is another complaint to which pregnant 
women are liable. This is hurtful in its consequences, 
being not uncommonly the cause of fever, tenesmus, pain 
in the bowels, and abortion. Care must be taken to ob- 
viate costiveness by the use of such food as will have a 
laxative effect. The use of graham bread, oatmeal gruel, 
raisins, figs, grapes, roasted apples, baked pears, brown 
bread, cracked wheat, stewed prunes, and other varieties 
of farinaceous food and fruit, may obviate the necessity of 
taking opening medicines (F. 108, or milk of magnesia.) 
An enema is an excellent remedy, and every lady should 
have a good enema apparatus, by which she can adminis- 
ter an injection to herself, and if she suffer from constipa- 
tion, she should take an enema twice or three times a week, 
and the early morning is the best time. The clyster may 
be warm water, or castile soap and water, of the tempera- 
ture of new milk. It may be well to give occasionally an 
aperient to insure a thorough clearance of the whole bow- 
els, and castor oil, salad oil, citrate of magnesia, seidlitz 
powder, stewed rhubarb, or an electuary of figs may be 
given. I sometimes direct that the woman should take 
every day a small dose of oil, in a cup of water gruel or 
oatmeal gruel. 

Severe pain in the bowels and rectum is sometimes 
caused by a column of hard and indurated feces, which 
remain for a number of days in the rectum and colon. 
Not only pain but inflammation, and other serious ills, may 
result if such a condition is neglected. If taking injec- 
tions does not suffice to give relief, manual assistance is 
necessary. The nurse should learn the art of removing 



24 Mother, Nurse and Infant. 

them if necessary ; she should use a convenient instru- 
ment, carefully conducting it into the anus, or she may 
thrust her finger into the vagina to break the hard mass, 
and assist in its expulsion, then she should wash it out 
with repeated clysters. 

For abdominal pains that are caused by its distention, 
and by the weight of the enlarged uterus, the woman should 
wear a bandage, or an abdominal supporter, adjusted to 
fit the abdomen, and made with proper straps and buckles 
to accommodate the increasing size of the abdomen. To 
relieve the pain, the abdominal walls may be rubbed with 
equal parts of sweet oil and laudanum. 

Troublesome hemorrhoids may be caused by consti- 
pation, and also by the congestion in the parts, and by the 
pressure made on the vessels of the part by the enlarged 
uterus. It is proper sometimes to use emollient fomenta- 
tions and cataplasms. Relief may often be given by mak- 
ing firm and gentle pressure between the finger and thumb 
of each distinct tumor, till they are all compressed and 
returned within the anus. 

In cases of bleeding piles, blood comes away each 
time the patient has a stool. The patient ought to be as 
quick as possible in relieving the bowels, and should not 
at such times sit one moment longer than is absolutely 
necessary. If the piles are inflamed and painful, foment 
them three times a day, and for half an hour each time, 
with hot water containing a little carbolic acid — a one per 
cent, solution. Apply it by means of a sponge. Extract 
witch hazel may be used also, and relief may often be ob- 
tained by sitting over the steam of hot water for fifteen or 
twenty minutes. Simply put hot water in a close vessel, 
and sit over it. Sometimes the woman cannot sit in an 
ordinary chair, and she should sit either on an air cushion, 



Pregnancy. 25 

or a water cushion half filled with water, placed on the 
chair. (F. 107.) 

Diarrhcea is a less frequent attendant of pregnancy 
than constipation, and the latter is sometimes the cause of 
the former ; in such cases an aperient is required. (F. 
109.) Should the complaint remain after the operation of 
the laxative, opiates are proper, mixed with some mild as- 
tringent medicine, aromatics, antacids, etc. (F. 69, 74, 79, 

80.95-) 

Tenesmus, and also diarrhcea, are common attendants 
on abortion, of which they are, indeed, sometimes the 
cause. Ipecac in half grain doses, with powdered opium, 
and given every six hours ; or frequently repeated doses 
of opium may be needed. (F. 91, 92.) A flannel bag filled 
with hot table salt, and applied near the part affected, may 
give great relief to pain. 

Heartburn is a common and often a distressing symp- 
tom of pregnancy. I would prescribe in such cases an 
abstemious diet, pepsin, ingluvin, and other medicine to 
help digestion; antacids and laxatives. (F. 71, 72, 74.) 
Calcined magnesia is good ; prepared chalk is harmful. 

It is not necessary for me to dwell upon the few ail- 
ments that occasionally afflict pregnant women that I have 
not yet referred to, — a few words must suffice. If a wo- 
man who is pregnant is apt to be faint, or to faint away, 
I advise that she be laid down — that she lie flat on her 
back, with a pillow under her head — that tight articles of 
dress be loosened — windows raised — water should be 
sprinkled on her face, a few drops of aromatic ammonia 
may be administered, and perhaps smelling salts or harts- 
horn held to the nose. If it is simply fainting, it is not 
dangerous. 

A nervous pregnant woman is sometimes subject to 



26 Mother, Nurse and Infant. 

palpitation of the heart, especially when lying down. 
A small dose of aromatic ammonia will generally give relief. 

If cramps of the legs or thighs are troublesome, take 
F. 92, and tie a handkerchief around the limb, above the 
part affected, and let it remain a few minutes, and use fric- 
tion. If cramp attacks the bowels or back, a hot bag of 
salt, or a stone bottle filled with hot water and wrapped in 
flannel, may be pressed against the part, and something 
similar should be placed to the sole of the feet. 

If pruritis pudendi — irritation and itching of the ex- 
ternal parts — are troublesome, use F. 195, 217, 220, and 
take frequently a tepid salt and water sitz bath, remaining 
but a short time in the bath. If the parts are hot and in- 
flamed, and covered with an eruption, use either of the 
following lotions : F. 217, 195. 



CHAPTER IV. 

INSTRUCTIONS TO A WOMAN DURING THE LAST MONTH 
OF PREGNANCY. 

i. Do not take too much exercise. — You may get re- 
lief from some of your ailments by lying down considerably 
during the day. If there is lucorrhcea (whites), strangury 
(a frequent inclination to void the urine), incontinence (an 
inability to hold the water), pain in the hips with numb- 
ness of the inferior (lower) extremities — if the veins of the 
leg become varicose — if there are anasarcous swellings of 
the inferior extremities — if there is a pendulous belly, the 
woman ought not to so exercise as to produce fatigue. 
She may get some relief by sitting or reclining in the way 
that is most agreeable. 



Pregnancy and Confinement. 27 

2. Use means to harden the nipples. — Those women 
who have never had children ought to observe, before 
labor, whether there is a depressed condition of the nip- 
ples ; whether they contract as the breasts increase in size. 
If they do, the condition can be corrected by wearing nip- 
ple shields on them. And to harden the nipples : For at 
least a month before labor, two or three times a day, rub 
them between the thumb and finger, and bathe them in 
tincture of myirh or cologne water, in which a little alum 
has been dissolved. This will render the skin less sensi- 
tive, and avert the distress occasioned by the tenderness 
of the nipples. If there is especial reason to apprehend 
excoriated nipples, as there is when they are rough and 
nodulated like a strawberry or raspberry, make a solution 
of sulphate of zinc, one grain to the ounce of rosewater, in 
a w T ide-mouth bottle, and tilt the bottle upon the nipple, 
and allow r it to remain there for a few minutes, several 
times every day (F. 198, 217.) It is necessary also to 
protect the part from the pressure of stays and the friction 
of the flannel vest. The stays may be removed entirely, 
or the nipple may be protected by laying a soft linen rag, 
w r et with w r ater and cologne, around it so that the pressure 
will not be directly on the nipple. If the breasts are 
swollen or painful, the soreness will subside of itself be- 
fore the commencement of labor. It may be well, how- 
ever, to foment them with flannel wrung out of hot water, 
and support them as in a sling by a broad handkerchief, 
passing over the opposite shoulder. 

3. Pay no attention to the chilling and " horri- 
fying tales of gossiping beldames." — A cheerful flow 
of spirits which arises from the hope of a happy event, in- 
spires a woman with activity and resolution, and is the 
best preparation for the pains of labor. Do not give way 



28 Mother, Nurse and Infant. 

to gloomy and melancholy forebodings or indulge in idle 
reveries. Any person is your enemy who would exagger- 
ate to you the dangers of labor ; and let me here say to 
you, that if you read in this book of certain unfavorable 
contingencies, do not let your mind dwell upon them ; 
they occur very rarely indeed, and I hope I have given 
such advice and instruction, and that you have been so 
cautious and careful that your chance is unusually favor- 
able. 

4. DO NOT EXPOSE YOURSELF AT THIS TIME TO WET 

and cold. — Do not go out in bad weather, and do not go 
to theatres and ' other crowded places at all. You are 
especially liable at this time to renal difficulties, and if you 
take cold, it will cause congestion of the kidneys, and more 
or less urinary difficulty. It is easier to prevent such com- 
plaints than to cure them. 

5. Take but little medicine. — In general you may 
rest in the hope that all your troubles will vanish after 
your confinement, and you can hardly hope to cure them 
sooner. But keep your bowels loose. If you cannot have 
daily passages by eating fruits, bread made from unbolted 
flour, or other laxative diet, take saline waters, compound 
licorice powder, etc., (F. 108.) If your bowels are consti- 
pated at the time that labor commences, take at that time 
an active cathartic (F. 109). 

6. Seek and engage the best possible physician. — 
I do not know but the educated monthly nurse of the 
future may be well qualified to do all that is necessary in 
an ordinary natural parturition. But heretofore very few 
nurses trained in this country are thus prepared ; perhaps 
the popular sentiment is against such an education. But 
you must always select a physician that you can confide 



Pregnancy and Confinement. 29 

in and trust if an operation is necessary, or there is unus- 
ual difficulty. 

7. It is generally well to have your physician 
see you a month before the time that you expect 
TO be confined. — Indeed, I would have you consult with 
your physician during the whole period of your pregnancy. 
You may get very full directions from this book, but still, 
where it is practicable, I advise that you consult with some 
skilled medical friend, who knows your idiosyncracies, and 
can suggest modifications of the directions as your own 
case demands. Specimens of your water should be an- 
alyzed each week during the last month, if there are any 
signs of albuminaria, etc., (especially if the face and ankles 
are bloated.) If there is inability to pass the water, it may 
be necessary to draw it with a catheter. 

8. Submit yourself entirely to the direction of 
your physician. — Do not indulge in any opinion that may 
clash with his, even if that opinion is founded upon what is 
here written ; you cannot expect to know more than he. 
It may be that he will wish to examine you by palpation, 
etc., to know if the foetus lies as it should do, as some- 
thing may be done to correct a malposition by external 
manipulation if the effort is made early. No good physi- 
cian will permit that your sensibilities should be shocked 
by an unreasonable demand. If you have studied this 
book diligently you will be prepared to converse intelli- 
gently with your physician, and you will understand and 
appreciate any directions that he may give. If you have 
taken any medicine prepared from formula herein insert- 
ed, you know, and can inform him what the medicine is ; 
this is better than it would be if you had taken patent 
medicine, of the ingredients of which you are ignorant. 
Consult with your physician in regard to the choice of a 



30 Mother, Nurse and Infant. 

nurse, as he will be likely to know those that understand 
their business, and that are in the habit of following the 
doctor's directions, or he may know whether the one you 
selected is now attending a woman that has contagious 
disease. - 

9. Choose a good nurse. — You should have the best 
possible aid that the nature of circumstances will permit. 
Do not get a fine lady nurse that requires to be constantly 
waited on by a servant, and do not get a croaker that dis- 
courses of the sad and dreadful cases that have occurred 
in her experience. Do not get any one that is addicted 
to intemperance, or a potterer that is devoid of method 
and efficiency ; that does the wrong thing in the wrong 
way, and that is always out of her proper place. Get a 
nurse that will not dose and medicate either the mother or 
child when they are under the care of a physician, or as- 
sume any duty or responsibility that belongs to him ; that 
admits that the doctor is the one to give orders. Get one 
that never reveals the private concerns of her former em- 
ployers ; one that is not a mischief-maker, causing dissen- 
tion and disagreement in the household. Do not get one 
that is young, if she is giddy and thoughtless and inexperi- 
enced, nor one that is old, if she is deaf and stupid. Get, 
preferably, a married woman or a widow ; one that has at 
some time had the care of infants ; one that has a pleas- 
ant countenance, and is naturally cheerful ; one that has 
calmness and self possession, and firmness, and at the 
same time is gentle, kind, good-tempered and obliging ; 
she should have a light step, a pleasant voice, a cheering 
smile, a dextrous hand, a gentle touch, and be gifted in 
cooking for the sick. By preference, engage a monthly 
nurse ; she will not be so likely to come to you from a 



Pregnancy and Confinement. 31 

case of scarlet fever or erysipelas, or other contagious dis- 
ease. 

If you can find a nurse of the kind described above, and 
if she be properly instructed and educated, she will be 
invaluable to you, and if she devotes her talents and her 
best energies to you and your infant, she should be liber- 
ally paid. But there are many such women all over the 
country, or will be when we can induce them to qualify 
themselves by study and special effort. But, as really 
good nurses are full of engagements, it may be necessary 
for you to engage her in the early months of your preg- 
nancy; only stipulate in the start that you will be obliged 
to dispense with her services, if it happens that immedi- 
ately preceding your confinement she had been attending 
a woman that had puerperal fever. 

I do not say that you should necessarily engage a nurse 
that is educated as a midwife. But such a one is to be 
preferred even if you have a physician, and then the latter 
need not be detained from his patients for so long a period 
of time; and if the last stage of the labor is so rapid that 
the child is born before the doctor arrives, there need be 
no trepidation ; she will know well what to do. Thou- 
sands are born in this country without the slightest assist- 
ance from a doctor, he not being at hand nor not being 
in time, and yet both the mother and babe do well almost 
invariably. As a rule the nurse that has studied and 
learned the most is the best .prepared to discharge the 
duties resting upon her. 

A NURSE MAY PROPERLY BE IN ATTENDANCE A WEEK 
OR MORE BEFORE THE TERMINATION OF PREGNANCY, if 

circumstances permit or require it. If present she will 
attend to the following things : Choose a good airy room 
for the lying-in chamber — one that can be well ventilated, 



32 Mother, Nurse and Infant. 

where the temperature can be kept at from 6o° to 65 °; 
one that is removed as much as possible from noise and 
disturbance, and where the patient need not be exposed 
to draughts. Provide needed articles of clothing for 
mother and child, and dressings for the bed; short gowns 
to wear over the chemise or ordinary night gown; a proper 
bandage of heavy muslin, as much as one and a quarter 
yards in length and fourteen inches in width. I prefer to 
have it of several thicknesses, and if it is quite long so 
that the ends meet to be folded it keeps in place better, 
and if it is gored it should be in such a manner that it is 
narrower at the lower edge than it is two inches above, 
so as to prevent it when adjusted from sliding upwards ; 
the child's binder, preferably some woolen material about 
five inches in width and fourteen inches in length ; the 
child's shirt (woolen or cotton, not starched) ; both a 
long and a short petticoat ; a frock or slip ; a shawl or 
flannel blanket ; napkins and muslin diapers ; also pieces 
of old muslin to be used to absorb blood and water. 
Provide also for dressing the bed, a piece of impervious 
oiled cloth, oiled silk, or rubber cloth ; old sheets and 
comfortables ; a piece of carpet ; have in readiness a pair 
of shears or scissors, a small box of prepared lard or vas- 
eline or a flask of salad oil, a package of pins one and a 
half inches in length, besides ordinary pins; tape, bobbin 
or wrapping twine; fine toilet soap; fine sponge for wash- 
ing the child; soft linen or carbolated cotton for dressing 
the naval; a box of unirritating powder; a pile of towels, 
and a little aromatic ammonia or brandy to be used in an 
emergency. Let every thing be placed in such order that 
either may be found without hurry or bustle at a moment's 
notice. Hot and cold water should always be in readi- 
ness. 



CHAPTER V. 

DIRECTIONS TO THE MONTHLY NURSE. 

If you attend a woman to whom the physician has al- 
ready been called, you will thereafter be subject entirely 
to his orders. Whatever your opinion is, notwithstanding 
you have this book or any good authority for your opinion, 
if it seems to conflict with his directions, obey him; on 
him rests the responsibility and he is presumed to know 
what is best. But it is best that you should confide in 
each other — be on such relations that you can communi- 
cate to him anything you have learned about the case; be 
free to ask of him explicit directions and instructions. 
But your duties may precede his as well as accompany 
them, and I wish now to give special directions in regard 
to things that first demand your attention. 

i. A nurse may properly provide a soft rubber catheter 
and also a syringe; this should be constructed so that it 
acts as an enema apparatus when one pipe is used, and as 
a vaginal syringe when the other pipe is applied. The 
holes in this pipe should be made so that the fluid injected 
is thrown backward. 

It is important that this last direction be observed. I 
know of one instance where the vaginal pipe of a David- 
son syringe was used, yet the fluid injected passed through 
the cavity of the uterus and through the Fallopian tube 
and entered the cavity of the peritoneum, causing severe 
pain and inflammation. 



34 Mother, Nurse and Infant. 

Besides the things already mentioned, I advise that 
there be furnished for use if needed a small blanket to 
receive the baby, a little bath tub, two chamber vessels, a 
bed pan, carbolic acid, fluid extract of ergot, and chloro- 
form. 

2. Being employed as a monthly nurse, do not (except 
very rarely indeed in an emergency) give any medicine at 
all or any stimulant that has not been ordered by the at- 
tending physician. Many women do not consider that 
labor is a natural process; it is painful indeed, and often 
lingering and tedious, but will go to a safe termination 
ordinarily without interference; any medicine given, unless 
very wisely administered, is much more likely to do harm 
than good. 

3. Be still and noiseless as possible in doing necessary 
duties when your patient is trying to sleep, or when she is 
in special need of sleep. Sleep may be of great import- 
ance to her, and it may be put to flight by a little careless- 
ness in renewing the fire, or in walking if you wear heavy 
and creaking shoes. Nurses at these times should wear 
slippers and not shoes. 

4. If you attend the lady for a week or more before 
the doctor is called, there may be different ailments which 
you ought to note, at least enough to know their true 
significance. Perhaps she has false pains, and suffers so 
much that she believes that labor has commenced. You 
will decide partly from the character of the pains. False 
pains are colicky, though they may shift occasionally from 
the bowels to the back and loins and may extend to the 
hips and thighs. They come at irregular intervals, are 
sometimes violent and sometimes feeble, and they are 
particularly troublesome at night. 

Spurious pains are often caused by disordered stomach 



Pregnancy and Confinement. 35 

and may be somewhat relieved by attention to the diet 
and by mild aperients (F. 108, 109), or by applying a 
flannel bag of hot salt. If quite severe send for the doctor; 
do not give stimulants. 

5. You may benefit the patient at this particular time 
when labor is approaching, perhaps without giving her 
medicine. Possibly she may feel very well for a day or 
two, and you will need to direct her exercise so that she 
does not do too much. You may keep from her unpleas- 
ant sights and seeming dangers; keep her room from being 
overheated; see that she does not have late suppers, too 
great a quantity of food, or anything that will produce a 
costive state of the bowels. See that her clothing is not 
too light, that she does not have strong tea or coffee, and 
that she does not lie too much in the bed. Secure as 
much as possible tranquility and equanimity, by guarding 
against gusts of passion, by keeping from her tales of 
horror and disaster which have happened to the pregnant, 
by teaching her that she has nothing to fear in regard to 
her child from the simple fact that some longing has been 
ungratified or that she was appalled at some frightful ob- 
ject, as such fears are seldom if ever realized; relieve her 
if possible of gloomy forebodings by informing her how 
rarely death happens after a well conducted labor. 

6. If you give any medicine at this time give only that 
which is unirritating and mild. 

7. Notice all the indications of approaching labor, 
the sinking down of the uterus in the pelvis, the contrac- 
tions of the womb that come on without pain, or with 
slight pain, the change in the mind and temper of the 
lady, the augmented mucous secretion, &c. 

8. Although there is usually a sensation of buoyancy 
and lightness accompanying or preceding the setting in of 



36 Mother, Nurse and Infant. 

labor, there may be on the other hand a feeling of anxiety 
and depression of spirits. Be very careful that you are 
not betrayed into any manifestations of impatience ; no 
words but those of gentleness and encouragement and 
hope should fall upon her ear. 



CHAPTER VI. 



CARE OF THE MOTHER DURING LABOR AND CONFINEMENT. 

True labor pains are distinguished from the false by 
the fact that they are felt considerably in the back, pass- 
ing down to the thighs, and by their coming on at regular 
intervals. At first they recur nearly every two hours, and 
they steadily increase in number and frequency, and are 
grinding in their character. There are other signs which 
denote the actual commencement of labor; there is usually 
a frequent desire to empty the bowels and bladder, per- 
haps shiverings or rigors unattended with a sensation of 
cold, sometimes a severe rigor, and these signs are prece- 
ded or accompanied or followed by a discharge of mucus 
and blood, called the show. 

It is well now to send for the medical man, though if 
he lives near by it is only necessary to let him know that 
his services may shortly be required. If the patient suffers 
from nausea, vomiting, or chills and shiverings, let her 
know that they are only incidents of her labor and not 
unfavorable. Do not let her increase the pains or attempt 
to increase them in any way; it is much better that the 
labor should progress in a natural manner, even if it is 
very slow. 



Pregnancy and Confinement 37 

The preparation of the bed for the occupanc) oi 
the mother is now to be attended to. Cover the right 
side of the bed (as the patient will probably lie on her 
left side) with a piece of water-proof cloth or oil cloth ; 
upon the top of this a sheet is to be placed and fastened 
with safety pins. Over this permanent dressing (on the 
top of the bed sheet) a neatly folded draw sheet is adjust- 
ed (and a second rubber and draw sheet is desirable), 
which, after the labor, can be removed, leaving the first 
clean and dry. This second draw sheet and rubber, and 
also a folded comfortable can be placed a little nearer the 
foot of the bed than the other, and after the lady's con- 
finement she can be drawn up on the permanent dressing, 
and the temporary dressing can be easily removed. The 
other bed-clothes may be adjusted in the usual manner. 

A piece of carpet can be thrown on the floor by the 
side of the bed, and it is well to have a hassock to put be- 
tween the patient's feet and the foot-board or bed-post. 

To dress for the occasion, a folded sheet should be 
adjusted around the waist (or, instead of this, or above 
this, a petticoat), to extend from the waist to the feet. 
(These will be removed after the delivery.) Then a che- 
mise should be put on in the usual manner, and drawn 
up and folded high under the arms. She should then 
have on a clean nightgown, and over it a warm wrapper ; 
this can easily be slipped off when she is about to go to 
bed, and the night-dress, if it is a long one, can be folded 
up under her arms, so that it will not be soiled. 

The stays must not be worn, as that prevents the free 
action of the muscles of the chest and abdomen. The 
patient, during the first stage of labor, may walk about or 
sit down, and need not confine herself to the bed. She 



38 Mother, Nurse and Infant. 

may be allowed such food as she can eat, but should not 
be urged to take food. 

The best beverage for her is either a cup of warm 
tea, or of gruel or arrowroot. Cold water will not hurt 
her if she desires it. A patient ought, during labor, fre- 
quently to pass water. Some women, from false delicacy, 
do not attend to it, and suffer severely for it. 

The doctor ought to have some room to retire to 
that the patient may be left very much to herself, and 
that she may have opportunity whenever she desires to of 
thoroughly emptying either the bladder or bowels. It is 
better that not more than two women be present with her, 
and even one of these can be dispensed with if necessary. 

The room should be kept quiet. — Let the attend- 
ants be quiet and self-possessed, and let there be no noise, 
or excitement, or whispering. There may be ordinary 
cheerful conversation, but when the pains become very 
frequent and severe, it is best that this should be hushed 
enough to have the patient feel that the attendants are not 
neglectful of her, or careless about her. Cheerful words 
spoken to the patient of the blessed relief that will come 
after enduring so much pain will do good. 

When the membranes are ruptured and the waters dis- 
charged, the doctor should be called in immediately. 
When he is present you will be subject entirely to his 
direction. 

If the medical man cannot be present pretty soon, I ad- 
vise any nurse who has diligently studied this book to 
make a digital examination, and ascertain if there is a 
head presentation ; if there is, there need not be any anx- 
iety about getting a doctor. 

If the child is born before the doctor has time to reach 
the house, let the patient be made to understand that there 



Pregnancy and Confinement. 39 

is not the slightest danger ; and, for yourself, observe the 
following directions : 

Ascertain if a coil of naval string be about the neck of 
the infant ; if there is, remove it immediately. See that 
it has room to breathe ; that there is not a membrane over 
its mouth, and that its face is not buried in the clothes or 
the discharges. If the child cries, give a minute's atten- 
tion to the mother, to see that she is in an easy position, 
and for a few minutes make pressure with one hand over 
her abdomen. If the child does not cry the moment it is 
born, give it a smart blow on the back, sprinkle a little 
cold water upon it, and put your finger in its mouth to 
remove any mucus that may interfere with respiration. 

After the child cries, and when no pulsation can be felt 
in the cord, tie and cut it. Tie with a strong and not too 
fine a string, about one and a half inches from the child's 
body, and cut so as to leave that portion of the cord at- 
tached to the child's body about two and a half inches 
long. Cut far enough from the ligature so that it will not 
be liable to slip off. The ligature should be drawn tight 
when applied, and it ought to be examined afterwards to 
know that it does not continue to bleed. 

I shall here summarize, in a very brief way, what you 
are to do in the absence of the doctor : After the child is 
breathing properly and the cord is cut, the mother may 
receive your attention. If the placenta is not expelled 
spontaneously, place one or both your hands over the 
uterus, and by friction, squeezing and pressure there, you 
will probably cause enough contraction of the womb to 
start the placenta from its attachments. You may then 
make slight traction on the cord, pulling only gently, and 
it will probably come down ; as it emerges from the va- 
gina gently twist or turn over the after-birth, and you will 
secure the removal of the membranes. 



4o Mother, Nurse and Infant. 

The soiled articles are now to be removed, a binder ap- 
plied, the patient placed nicely in bed and kept quiet ; no 
talking, no visiting, no excitement allowed. 

The baby may now be attended to — be washed and 
dressed. Have at hand a bowl of warm water, a small 
quantity of lard or oil, soap, fine sponge, and the articles 
of clothing, including a binder, and by preference a piece 
of flannel for washing. It is well also to have a small tub 
large enough to dip the child in. If the child is much 
covered with the " vernex caseosa," rub it over with some 
unctuous substance, and then wipe it off with the flannel 
or some soft cloth, being careful at the same time that 
nothing gets into the eyes of the child, and being careful 
to remove all the cheesy matter from the angles of the 
joints, and from behind the ears. Have the water for the 
bath warm, but not hot ; take hold of the feet of the child 
with your right hand and putting the left under its back 
and shoulders, lower it into the water, supporting its head 
by your arm. While supporting its head with your left 
hand, wash it all over, using toilet soap and (if you have 
it) a fine, clean sponge ; then lift it out into a warm towel 
and dry it thoroughly. Dust with fine starch powder, 
made of wheaten flour, under the arms and between the 
legs, and dress the naval by using a soft piece of linen 
dipped in vaseline and having a hole in the center. It is 
well to put another piece of linen around the cord, which 
may then be turned upward or to the left side, and the 
binder applied. Some prefer to put absorbant cotton 
around the cord. The binder or belly-band should be 
made of flannel, and should be cut bias. Care should be 
taken to apply it tight enough not to slip, but too tight an 
application should be particularly avoided. All the gar- 
ments of the child should be made subservient to comfort 



Pregnancy and Confinement. 41 

and not to show ; should be warm and not too small ; 
should consist in part of flannel during cool weather. 
When dressing the child put one garment inside the other, 
and put the whole on over the feet. But few pins need 
to be used if the clothes be properly arranged ; three pins 
are sufficient for the binder. The washing or dressing of 
the child should be done quickly ; a little cold water should 
be given it ; it should be all the time in a warm room, and 
may be laid where it is quite warm. 

The mother may demand a little more attention before 
the child is applied to the breast. A folded napkin should 
at first have been applied to the vulva. Look to it and 
see if it is much soiled with blood. When it is, apply a 
clean one, and observe particularly that one is placed so 
that it is partly under her ; observe if her bandage is well 
retained in its place, and if it presses well on the lower 
portion of the bowels. If the binder is kept w r ell adjusted 
it does good ; it is of no use if it is allowed to slip up from 
its place. A towel folded and laid over the lower portion 
of the bowels, under the bandage, is useful as a compress, 
and helps to keep the binder in place. 

Everything should be arranged so that the patient can 
have rest and quietness ; but before she goes to sleep put 
the child to the breast. If the nipple is retracted, an or- 
dinary tobacco pipe may be used to draw it out so that 
the child can get hold of it. If the child draw r s on the 
breast, the milk which it obtains will serve to physic it, 
and it should be applied to the breast every four or five 
hours ; nothing else need be given it, except perhaps a 
little sugar and water. 

If necessary to induce the child to take the breast, a lit- 
tle sweetened water or sweetened milk may be applied to 
the nipple. While the child is nursing the mother may 

*3 



42 Mother, Nurse and Infant. 

lay upon her side, and receive the child upon the arm of 
that side upon which she is lying. Perhaps, in order to 
draw out the nipple so that the child can grasp it in its 
mouth, it may be necessary to use some bottle with a flat, 
smooth mouth ; fill the bottle with hot water ; after a 
minute, empty it and place the mouth of the bottle imme- 
diately over the nipple ; as the bottle cools there will be 
sufficient suction to elevate the sunken nipple. 

Soon after the termination of the labor the woman may- 
partake of some light food — tea and toast, panada, or any- 
thing of a light, unirritating character. From the very 
first, under ordinary circumstances, the woman may be 
permitted to change her position as she may desire, from 
side to side, or to be propped up in bed. Before going to 
sleep she ought to urinate — in a lying position, if so in- 
clined, or she can be raised up and supported in a sitting 
position for a few minutes, if she desires to be. The 
•patient must not be allowed to exert herself, or remain too 
long in a sitting posture. But I have never known a wo- 
man to be harmed by being raised up and sitting for a 
minute at this particular time. 

Unless there is unusual suffering from after-pains or 
hemorrhage, or something that requires the attention of 
the physician, the patient will now be desiring and seek- 
ing sleep, and everything should be arranged for this 
object. 



CHAPTER VII. 

DIRECTIONS TO THE NURSE DURING THE MONTH. 

The nurse will receive from the medical man such direc- 
tions as the peculiarities of the case seem to demand, but 
I deem it proper here to give some general instructions. 
First, in regard to 

CARE OF THE MOTHER. 

Rest is essential to the mother during the month. She 
should remain in bed nearly all the time for at least two 
weeks, and should not return to her household duties un- 
der a month. -Perfect tranquility is essential, that the 
womb may resume its former size and situation, and that 
inflammation, ulceration, prolonged debility, pain and ex- 
cessive discharges be avoided, and that a good form be 
preserved. As a means of preventing a flabby, pendulous 
belly, she may also, when she does walk around, wear a 
utero-abdominal supporter or a well-fitting bandage. If a 
bandage is worn it should be made of strong linen, cut 
bias, setting snugly to the form, but not exerting unpleas- 
ant pressure. Its breadth should be from twelve to eight- 
een inches. 

The diet of a nursing woman should be both light and 
nourishing. I would suggest for the first day well-boiled 
gruel, bread and milk, panada, tea, dry toast and butter, 
or bread and butter. For the second day, beef tea may 
be added (F. 65), and she should be served with food four 



44 Mother, Nurse and Infant. 

times ; the third day she may eat a little chicken or game, 
and mashed potatoes or rice pudding, and on the fourth 
day she can partake once of mutton or beef. Arrow root 
(F. 44), with these articles mentioned, may form part of 
her diet thereafter, but she may partake of such articles 
of her former diet as are wholesome and nourishing. * The 
woman must not be starved ; she demands food that will 
allow her to recuperate her strength. Give her as nutri- 
cious food as she has appetite for, and can easily digest 
and assimilate. (F. 58.) 

For a beverage give toast water, barley water, and milk 
with the chill taken off and a little salt added, tea, cocoa, 
or chocolate made with one-half milk, new milk and water, 
cacao and broma, made with a large proportion of milk. 
Either of these may be freely used as a drink. I have 
always allowed my patients to drink freely of water from 
the first, and an occasional cup of coffee is not harmful. 
When the mother experiences any inconvenience from any 
articles of diet or drink, she should not hesitate to aban- 
don them, for if they disagree with her they will also dis- 
agree with the child. (F. 12, 18, 23, 52, 54, 57, 61, 62, 65.) 

The lochial discharge, which occurs directly after a 
lying-in, is at first of a reddish color, and gradually changes 
to a brownish hue, and afterwards to a greenish shade. It 
is necessary that there should be some discharge to con- 
tinue for a week, and it often continues for three weeks 
more. In some cases it has a disagreeable odor. 

Ablutions and cleansings are very necessary at this 
time. The parts should be carefully cleansed every day, 
and it is never amiss to use for this purpose a weak solu- 
tion of chlorinated soda, or carbolic acid, or permangenate 
of potassa, etc., (F. 153.) They may be used quite weak 
at first, and afterwards of greater strength, if they do not 



Pregnancy and Confinement. 45 

Tar water is excellent for an injection. 
The woman should daily assume a position that will facil- 
itate the discharge of the lochia ; sometimes get on 
her knees, or she may occasionally lie on her face and 
stomach. There should be no bandages applied so as to 
confine the secretions. A soft sponge and warm water 
may be used for ablutions at first, or the parts may be 
bathed with warm water and oat meal gruel ; after bath- 
ing they should be dried with warm, dry towels ; they 
may then, by means of a piece of linen rag, be anointed 
with salad oil or vaseline, or other bland oil. Once or 
twice a day the vagina should be syringed out with some 
injection. (F. 153, 155.) 

To wash or cleanse the patient so that the pores of 
the skin in every part are free and unobstructed, a soft 
napkin wet with warm soap and water, should be passed 
underneath the bedclothing, and she should be rubbed all 
over without any exposure to a draught of air. In some 
way she should take a sponge bath every day. 

The clothing which a patient will wear immediately 
after a labor has been already, indicated. As some gar- 
ments worn during labor are not necessarily soiled, they 
may be w r orn until the third or fourth day, when the dress 
should be changed. This may be done without tiring or 
exposing the patient. Without raising her up you can 
pull the bedgown down from over each arm, and after 
removing it from under the body, you can draw down the 
chemise and remove it from below. You can place her 
arms in the sleeves of the clean chemise, throw it over her 
head and pull it down ; and put on a clean bedgown in a 
similar manner, or both may be put on at once. 

The bed clothing as well as the body linen should be 
changed frequently. In changing the upper sheet it should 



46 Mother, Nurse and Infant. 

be pulled off from below, and the clean one can be carried 
down in its place without removing the other bedclothes, 
by plaiting the lower half of it. To put on a clean un- 
dersheet, plait one side of it, and place that under the 
patient while she lies on her side, then let her turn on her 
back or other side onto it, and draw out the plaited part. 
Care of this kind is necessary until she is able to sit. 
Have the sheets well aired, and have a proper temperature 
in the room. 

The lying-in room should always be kept well venti- 
lated and rather cool ; it is injurious to the patient to have 
the room kept at a high temperature. Perhaps the venti- 
lation can be secured by having a little fire in the room, 
and by occasionally leaving the door of the apartment 
ajar, at the same time being careful to guard against 
draughts. But visitors remaining in the room, or any ad- 
ditional number of persons, serve to vitiate the air, as well 
as to prevent the necessary repose of the patient. A sen- 
sation of chilliness may be felt by the woman after deliv- 
ery, and her feet may be cold ; if they are, something 
warm should be applied to them, and sufficient clothing 
should be on the bed ; but afterwards be careful not to 
overload her with clothes, as well as to avoid having the 
room overheated. 

Too much light in the room may be injurious to the 
eyes of the mother or child, and it is often necessary to 
darken the room somewhat for a few days. 

The lying-in woman will usually be confined to her room 
for two weeks. After the first fifteen days she may very 
properly remove to another room adjoining, or near at 
hand, and during her absence her room and bed may be 
ventilated by throwing the windows wide open and throw- 
ing the bedclothes back. Ordinarily she may, at the end 



Pregnancy and Confinement. 47 

of three weeks, take her meals with the family, hut she 
ought still to lie down occasionally to rest her back. At 
about this time she may take an airing in a carriage, if the 
weather be fine. 

All lying-in women ought not to be treated alike in re- 
gard to diet, etc. While a light, unstimulating diet is 
best at first in ordinary cases, the weak and delicate require 
good, nourishing food from the commencement, such as 
beef tea, chicken broth, mutton chops, eggs, etc., (F. 57, 
58, 59.) Oatmeal gruel increases the secretion of milk, 
is nourishing and easily digested, at the same time it 
is simple and bland, and proper for those that are corpu- 
lent, or strong and robust, and the same may be said of 
good cow's milk. But, as the healthy mother furnishes dai- 
ly from a quart to a quart and a half, she needs some meat 
to keep up her strength. Never give stimulants to increase 
the woman's strength, or to increase the quantity of milk. 

In some cases, after a severe and lingering labor, there 
is retention of urine. If the bladder cannot otherwise 
be emptied, the catheter must be used every six or eight 
hours. 

The bowels are usually costive after a confinement, and 
I prefer to give a dose of castor oil the third day. If this 
or some other aperient is not given, enemas should be ad- 
ministered sufficient to cause evacuations. 

The care of the mother's breasts is important. Be- 
fore the milk is abundantly secreted, she should not be 
fretted by very frequent ineffectual attempts at nursing, 
though it may be necessary to draw out the nipple by 
means of a breast pump. The milk should be drawn out 
when the breasts become full and distended, and they 
should not be allowed to remain hard and sore. Apply 
fomentations ; cabbage leaves, wilted in hot vinegar and 



48 Mother, Nurse and Infant. 

water, or warm solution of carbolic acid, one part to eighty. 
If they continue to be swelled and painful use F. 221, 223. 
It may be necessary to make gentle pressure upon them by 
means of strips of adhesive plaster, or by a sort of jacket 
or bandage, that should be prepared especially for the 
purpose. When the breasts are closely bandaged they 
should be supported on each side by pads of cotton, so 
that the pressure will be made equally upon them. 

Delay in applying the child to the breasts is often a 
cause of swelled breasts. After it has been fed for a few 
days it may refuse to nurse, and if it does nurse the nip- 
ple may be quite tender. But, unless for some cause 
the secretion is to be checked, the effort should be made 
every two hours to induce the child to draw. You will 
be more successful in these efforts if you can reduce the 
heat and swelling. Rub the breasts every four hours with 
good, warm olive oil, vaseline, or camphorated oil, and keep 
the excoriated nipple thickly coated with sub-nitrate of 
bismuth. 

The breast should be rubbed, and the child should be 
nursed regularly, although I do not advise that the child 
or the mother should be roused from their slumbers ; it is 
better to delay for awhile the usual effort. But, even at 
first, a child can be nursed with considerable regularity 
every hour and a half during the day, and twice during 
the night ; and it should be applied alternately to either 
breast, even if it seems to prefer one to the other. 

It is often necessary to wash the breast and nipple with 
warm water, and dry it with a soft napkin, before apply- 
ing the babe. 

During all the time that the mother nurses the child, 
the mind of the mother exerts an influence on the lat- 
ter through her milk. If the mother's mind is very much 



Pregnancy and Confinement. 49 

disturbed by any apprehensions, fears or anxieties, these 
perturbations will not only be likely to check the flow of 
milk, but will alter its quality, and perhaps render it 
hurtful and dangerous to the infant. The nurse should 
guard the patient as much as possible from anything caus- 
ing nervous agitation, fretting, anger, grief, fear, sudden 
terror, or great anxiety, as these are injurious to the moth- 
er, and may be harmful and fatal to the child. Equanim- 
ity and cheerfulness of mind on the part of the mother 
are important at any period of her pregnancy or nursing. 
I will now give more particular directions in regard to 

THE CARE OF THE CHILD. 

The food of the child, if it is necessary to feed it at 
first, may be one-third of new milk and two-thirds of 
warm water, slightly sweetened. It is not necessary that 
it should be fed for at least eight hours after birth, and at 
first the quantity fed it must be small. Except in rare 
cases the milk furnished by the mother will come soon 
enough, and in sufficient quantity to supply the wants of 
the child, and it is best for both that the child should draw 
it when secreted. For the instruction of the mother, as 
well as the nurse, I here quote a paragraph upon the nour- 
ishment and feeding of the child, not only of the new- 
born, but also of the subsequent months : 

" No form of artificial nourishment can compare with 
that furnished by the mother. Women should know and 
consider the probability of disease and death occurring 
from any other mode, and the difficulties and annoyances 
to be encountered in the use of artificial food. As a 
further inducement to her to nurse her own child, she 
should know that her offspring is sure to imbibe with its 
milk, deep, earnest affection. The mother who can nurse 
her own offspring should commence within eight hours 
after delivery, and in the mean time no trash should be 



50 Mother, Nurse and Infant. 

put in its mouth to still its cries, or for any other reason ; 
if it has not been surfeited, it will be disposed to take the 
breast. It should be placed to the breast before they are 
gorged with milk, for at that later time the flow is less 
easy, the parts are more irritable, and the child suck- 
ing with greater power, we are more likely to have, as the 
result, irritated nipples. Nature prompts all animals to 
suck their mother soon after they are born ; we are 
less liable to have sore, irritated, cracked nipples, and 
there is less liability to infantile colics, etc., if we follow 
the guidance of nature and instinct." 

As soon as possible accustom the child to the habit of 
nursing every two hours. If there is a proper interval be- 
tween the times of nursing, the child draws with more 
avidity, actually empties the breast, and obtains that 
part that contains the most cream. Endeavor also to 
have the intervals longer at night, so that, from 10 p. m. to 
6 a. m., it nurses but once or twice. Still, if it wakes 
every two or three hours, demands its supply of nour- 
ishment, and you cannot otherwise quiet the child, you 
must indulge it. Do not accustom the child to sleeping 
on the mother's breast. If it sleep in its own crib or bed, 
properly clothed and protected, it is less liable to have its 
rest disturbed. Avoid the custom of having a young 
child sleep with old and sickly persons, and also of having 
them sleep in ill-ventilated rooms, and of covering the 
child's face as it sleeps. There is danger that a child 
may die from want of pure fresh air, from having its face 
pressed tightly in the embrace of the person with whom 
it sleeps, from the multiplicity of its clothes, and from the 
mass of bedclothing used by the mother, as well as from 
improper food. A child should never be covered to sweat 
by reason of the warmth of its clothing, or of that of the 
apartment. 



Pregnancy and Confinement. 51 

If the mother does not enjoy good health, it may be 
better for her not to nurse the child at night, but to have 
it fed. once or twice with a little diluted cow's milk at 
night, and to nurse it during the day. 

The following have been named as causes why the 

MOTHER CANNOT PROPERLY NURSE THE CHILD : 

i. When she cannot have a sufficient quantity of milk. 

2. When the supply falls off from some defect which is 
not remediable. 

3. When there is a strong venereal or scrofulous taint 
in the constitution. 

4. When suckling produces an active or painful disease 
in the mother, as colic, etc. 

5. When the mother is subject to great nervous debili- 
ty ; possesses an irascible temperament, and cannot avoid 
grief and sorrow ; and also when she is suffering from 
certain hereditary chronic diseases. 

When a mother cannot suckle her child, if cir- 
cumstances will allow, a healthy wet-nurse should be pro- 
cured. Choose one that is of a healthy family ; ascertain 
that there are no eruptions on her skin, or if there be other 
disease ; if she have a plentiful breast of milk, and if it be 
of a good quality ; if she has good nipples, and if her child 
is born near the time that the one was that she is to nurse. 
Do not get a nurse that menstruates during suckling, nor 
one that has a child which is unhealthy, or has a sore 
mouth or blotches upon the skin. 

Very feeble new-born babes cannot take the breast some- 
times. In such cases cow's milk, water and sugar (F. 1) 
may be given in small quantities at a time, but frequently 
repeated. If it takes only a teaspoonful at a time it should 
be repeated every half hour. 

Many mothers are unable to obtain the services of a 



$2 Mother, Nurse and Infant. 

wet-nurse. The milk of a cow is the best substitute, and 
when this is of ordinary richness, it may be diluted with 
an equal quantity of water, or thin barley water. 

The following are leading principles to guide in giving 
infant food : 

i. Aliment should always be presented to the infant 
stomach in a fluid form. 

2. Bread and other farinaceous substances are general- 
ly indigestible in the infant stomach, and may better be 
excluded from infant feeding. 

3. Cow's or goat's milk, when pure and modified so as 
to resemble as much as possible human milk, will gener- 
ally be found sufficient without any other help to nourish 
the new-born infant. 

4. If cow's milk is used at first, diluted with twice as 
much water and slightly sweetened, the proportion of 
water must be gradually lessened, until after six months 
the milk may be given undiluted. 

5. When good milk from one cow cannot be obtained, 
and the child does not thrive upon the milk used, con- 
densed milk may properly be substituted. 

6. There are various forms of infant food referred to 
in F. 1, 2, 3, 4, 11, 28, 45, 49, and if one of these is tried 
and proves satisfactory, it will not be advisable to try new 
kinds of infant food which are at the present time offered 
for sale. Milk should be the basis of all infantile food ; 
neither starch, dextrine or glucose sufficiently nourishes 
without it ; but we may use one of these foods without 
milk for one or two days, in unsettled state of the stom- 
ach, with good results. (F. 61.) 

Thoroughly wash the babe every morning from 
head to foot, using a large wash bowl or nursing basin, 
half filled with water. First wet the head, then immedi- 



Pregnancy and Confinement. 53 

ately put the body in the bath, and with a sponge or piete 

of flannel, cleanse the whole body, particularly the arm- 
pits, groins, and between the thighs. The skin, after be- 
ing thus cleansed, must be quickly and thoroughly dried 
with soft towels, and the parts liable to become sore, pow- 
dered ; then all parts of the body and limbs should be 
gently rubbed. During all the time, when the child is but 
a few days old, it should not be exposed at all to the cold. 
The water for its bath should be slightly warmer than 
new milk, and the time occupied in the bathing should be 
short. Each time, after a passage from the bowels, the 
parts should be washed with warm water, and if there is 
any chafing the calamine powder should be applied. 

The naval string should receive the attention of the 
nurse ; within an hour of the time it is at first tied, she 
should examine the dressing to see if there has been any 
bleeding. If it bleeds, and the doctor isnot at hand, le- 
tie with a stout cord, drawing it quite tight. Each morn- 
ing, when the child is bathed, lift up the naval string with 
the rag dressing and insert a little nice fresh tallow under 
it. When it is loose remove it, but use no means to cause 
the separation. The naval is sometimes a little sore, but 
seldom needs any dressing more than simply vaseline or 
tallow. 

At night a child should be entirely undressed, and its 
clothing replaced by other garments, those that are loose, 
light, and sufficiently warm for it while it is under the bed- 
clothes. For a very young child the proper night-dress is 
a loose slip ; when older, a pair of drawers, fitting up well 
around the neck and covering the body and limbs, is a 
good article. The clothing worn during the day should 
not be worn at night, and the clothing when soiled should 
be immediately changed. Whenever the child seems dis- 



54 Mother, Nurse and Infant. 

posed to sleep, this should be encouraged. Never arouse 
a child suddenly from its sleep. Be careful that there is 
no unnecessary noises to disturb its sleeping. Time the 
bathing and dressing so that the little one may not be un- 
necessarily disturbed. But never give soothing syrups, 
anodynes for infants, or other nostrums to induce them 
to sleep. If the child is restless, endeavor to ascertain if 
there is not some cause that can be removed, such as tight 
clothing, etc. 

Premature infants may, under favorable circum- 
stances and assiduous care, live and thrive. Immediately 
after birth the child should be placed in a warm bath, and 
then wrapped in cotton. The baths should be warmer 
than usual, and must be frequently repeated. Awaken 
the child every one or two hours to feed it. Milk (wo- 
man's milk is the best) must be given it by a teaspoon. 
With a view to the better development of the lungs, it may 
be excited to cry by a slight irritation. Do not bring such 
children into the open air for several months after the 
birth, as their passages are readily affected. 



PAI^T II. 
ANATOMY AND PHYSIOLOGY 

OF THE FEMALE ORGANS AND FCETAL DEVELOPMENT, 



CHAPTER I. 

OF THE PELVIS. 

The formative organs of generation are situated within 
a large cavity, called the cavity of the pelvis, the walls of 
which are composed of bones and soft parts. This basin 
(in Latin, pelvis) is an irregular, long cavity, situated at 
the base of the spinal column, and above the inferior ex- 
tremities. In the adult the bony pelvis may be divided 
into four parts or bones, viz : the os sacrum, two ossa in- 
nominata, and the os coccygis, but in early life they are 
more minutely divisible. 

THE SACRUM. 

The sacrum (Fig. i) terminates the vertebral column, 
and is perhaps the most important bone in the pelvis, ob- 
stetrically considered, as it enters largely into the various 
deformities of the pelvis. In the adult it is of a triangular 
shape, the base of the triangle being above and inclining 
forwards, the apex" below and somewhat backwards ; its 
length is from four to four and a half inches ; its breadth 
about four inches, and the greatest thickness, two and a 



$6 Mother, Nurse and Infant. 

half inches. The internal surface is concave to the amount 
of half an inch, crossed by four transverse lines, marking 
the former division by cartilage ; here are four pair of 
holes, through which pass numerous nervous filaments, 
which afterwards form part of the great sciatic nerve. 




Fig. i — A represents the internal or anterior surface of the sacrum. 
B B " articular processes. 

C C tl anterior sacrel foramen. 

D articulating surface. 

It is placed at the posterior part of the pelvis, where it 
appears like a wedge forced in between the ossa innomin- 
ata, immediately below the vertebral column and directly 
above the coccyx. 

THE OSSA INNOMINATA. 

The os innominata (nameless bone, Fig. 2) is of a very 
irregular figure, and the pair occupy the lateral and an- 
terior parts of the pelvis. The external or femoral surface 
is turned backwards and downwards, as well as outward ; 
at its superior part, inferiorly it looks downwards. To- 



Anatomy of the Pelvis. 57 

wards the front, the external face presents the cotyloid 
cavity, or the acetabulum ; a little more in advance and 
below is the subpubic or obturator foramen, which is near- 
ly closed by the obturator ligament. 

Fig. 2. Right os innominatum, external surface. 




Fig. 2 — Represents the external surface of the right os innominatum. A. The ex- 
ternal iliac fossa ; B, crest of the ilium ; C, anterior superior spine of the ilium ; 
D. anterior inferior spine of the ilium ; E, horizontal branch of the pubis ; F, 
posterior superior spine of the ilium ; G, posterior inferior spine of the ilium ; 
H, acetabulum ; I, ischium ; K, obturator foramen. At birth the haunch bone, 
or os innominata, is composed of three bones connected by cartilage. Fig. 3. 

The superior portion of the bone is characterized on its 
abdominal or internal face by a large excavation called the 
internal iliac fossa (Fig. 4.) This portion is terminated 
below by a large rounded and concave line. The inferior 
(lower) portion presents behind a nearly triangular plane 
surface ; near the middle of this is the obturator foramen, 
and in front is the internal face of the os pubis. 



Mother, Nurse and Infant. 

Fig. 3. Left os innominatum, external surface, etc. 




Fig. 3 — Left os innominatum, partly ossified. The haunch bone as it exists in the 
child. A, pubis ; B, ilium ; C, ischium. 

Fig. 4. Right os innominatum, internal surface. 







Fig. 4 — Right os innominatum, internal surface. A, internal iliac fossa ; B, anteri" 
or superior spinous process of the ilium ; C, crest of the ilium ; D, posterior supe- 
rior spinous process of the ilium ; E, posterior inferior spinous process of the 
ilium ; F, articular surface ; G, spine of the ischium ; H, tuberosity of the 
ischium ; I, obturator foramen ; K, ischia pubic ramus ; L, crest of the pubis ; 
M, the pectineal eminence. 



Anatomy of the Pelvis. 



59 



THE OS COCCYGIS. 

The os coccygis (Fig. 5) is three or four little bones 
Fig. 5. united together on the median line of the body, 
and attached to the os sacrum. Each little 
bone is tipped with cartilage, and they are so 
united as to be movable. The entire bones 
The os coccygis. form a pyramid, the apex of which is below. 
The internal surface is smooth, like that of the sacrum, 
terminating the plane of the sacrum and bounding it an- 
teriorly. 

Fig. 6. Vertical section of the pelvis. 




Fig. 6 — Inlet, outlet, and axis of the pelvis, a, b, plan of inlet — superior strait ; 
c, d, plan of outlet, or inferior strait ; e, f, axis of cavity ; g, the coccyx ex- 
tended as it is in labor. 

Of the joints of the pelvis it is only necessary here 
to say that there is no motion in them to facilitate labor, 
except that the sacro-coccygeal joint is of the kind called 
ginglymoid, admitting of extensive motion, especially back- 



60 Mother, Nurse and Infant. 

ward, so as to permit the enlargement of the lower outlet 
an inch or more. (Fig. 6.) 

OF THE PELVIS IN GENERAL. 

We will now consider the pelvis collectively or as a 
whole ; its relation to the rest of the body ; its magnitude, 
axis, etc. It is connected with the trunk by the articula- 
tion of the sacrum with the last lumber vertebra, effected 
in the same manner as the junction of the vertebra with 
each other ; with the lower extremities it is connected by 
means of the hip joints. When the pelvis is in situ, the 
brim is neither horizontal nor perpendicular. It repre- 
sents a cone, slightly flattened from before backwards, the 
base of which being above, while the apex is directed 
downwards. 

When the body is erect the upper part of the sacrum 
and the acetabula are nearly on the same descending line, 
the point of the os coccygis being a little above the arch of 
the pubis, and the sacro-vertebral angle three inches and 
nine lines higher than the pubis. Were it not for the ob- 
liquity owing to the upright position of the human female, 
the womb would gravitate low in the pelvis, and produce 
most injurious pressure on the contained viscera. The 
lower or true pelvis is the part involved in parturition, and 
its size and shape demands our attention. 

THE BRIM OF THE PELVIS. 

This is defined by the lineo ilio pectinea, which 
marks the boundary of the true and false pelvis, and this 
superior strait is the entrance of the lesser pelvis. Its 
form has been variously described as being oval, heart- 
shaped, and triangular. If we call it ''triangular with an- 
gles rounded off," the base of the triangle is behind and 
the apex in front. It would be nearly oval were not the 



The Pelvis. 



61 



oval form broken by the promontory of the sacrum. This 
brim is the first solid resistance the head of the foetus 
meets in its descent through the pelvis. 

DIAMETER OF THE PELVIS. 

Different estimates are made by different anatomists of 
the measurements of the brim of the pelvis. The follow- 
ing is nearly the correct size of the ordinary female pelvis : 

Fig. 7. The bony pelvis. 




Fig. 7 — The pelvis seen from above, a a, The antero-posterior or sacro-pubic di- 
ameter ; b b, the transverse diameter ; c c, the two oblique diameters. 

The circumference varies from thirteen to fifteen inches ; 
the antero-posterior diameter, i. e., from the prominence 
of the sacrum to the upper edge of the symphasis pubis, 
(Fig. 6), is about four and a quarter inches ; the transverse 
across the widest part of the brim, at right angles to the 
antero-posterior, is five and a quarter inches, and the 
oblique from the sacro-iliac synchondrosis of one side to 
the opposite of the brim, just above the acetabulum, is five 
inches. (Fig. 7). 



6 2 



Mother, Nurse and Infant. 



The cavity of the pelvis, of which the fixed bound* 
aries are the sacrum and the pubis, is of unequal depth. 
The height in front is one and a half inches ; upon the 
sides, three and three-quarter inches, and it is four and a 
quarter inches if a straight line be drawn from the sacro- 
vertebral angle to the point of the coccyx, five and a 
quarter inches following the curve of the sacrum, and six 
inches if the coccyx be extended. (Fig. 6). 

The antero-posterior diameter of the outlet from the 
arch of the pubis to the point of the coccyx is usually 
four and a quarter inches, but may increase to five inches 
during labor by the retrocession of the coccyx (Fig. 8) ; 
the transverse from one tuber ischii to another is four and 
a quarter inches, and the oblique about four and three- 
quarter inches. 

It is important to notice that the diameters are entirely 
changed between the rim and the outlet, and that the 

Fig. 8 — Position of the pelvis and the axis at the termination of labor. 




Fig. 8— a b, Total axis of the excavation ; c, the axis of the superior strait ; d e, 
perineum as distended at the moment of the passage of the head. 

change is effected gradually. The axes of the inlet and 
outlet form an obtuse angle with each other (this is illus- 
trated in Figs. 6 and 8.) The three diameters taken at 



The Pelvis. 63 

the renter of the pelvis are very nearly equal — about four 
and three-quarter inches. 

DIFFERENCES OF THE PELVES. 

There is considerable difference between the male and 
female pelvis, in shape and size. The pelvis in the male 
is smaller but deeper ; the bones are thicker and the brim 
is more circular, the depth of the symphasis pubis is 
greater, the sacrum is more perpendicular, the arch of the 
pubis is narrower, the tuber ischii are nearer each other, 
and the coccyx less movable. In the female the iliac 
fossae are larger, the interval separating the angle of the 
pubis from the acetabulum is greater, causing the promi- 
nence of the hips and wider separation of the thighs, the 
superior straight is larger and more elliptical, the curve 
of the sacrum deeper and more regular, the tuberosities of 
the ischii are further apart, and the arch of the pubis 
broader. From the greater width of the female pelvis, 
and from the upper end of the thigh bones being farther 
apart than in the male, the thigh bones approach each 
other in their descent, giving a peculiarity to the move- 
ments of the female in walking. 

The soft parts lining the pelvis and covering it extern- 
ally modify the diameters of the pelvis, but the effect of 
these additions in diminishing the internal diameter is not 
very great. The diameter of the cavity is lessened there- 
by from one-fourth to one-half an inch. 

USES OF THE PELVIS. 

One function of the pelvis is to inclose and protect the 
bladder, rectum and seminal vesicles of the male, the uterus, 
Fallopian tubes and ovaries, as well as the bladder and 
rectum in the female. During labor it affords a passage 
for the child. 



64 Mother, Nurse and Infant. 

terminal outlet of the pelvic canal. 

This is not at the coccyx, but rather at the anterior- 
commissure of the perineum. This is so greatly distend- 
ed at the last moment of labor as to much prolong the 
posterior wall of the pelvic excavation and the canal to 
be traversed by the foetus. (Fig. 8). 

Fig. 9 — Section of sacrum and pubis. Fig. 10. 





Measuring superior strait. Measuring inferior strait. 



CHAPTER II. 

PARTS CONTAINED IN THE PELVIS. 

The internal organs of generation are the vagina and 
uterus with its appendages ; but I will first describe the 
urethra and the perineum. 

The urethra is a membranous dilatable canal about an 
inch and a half in length, and directed obliquely from be- 
fore backwards, and from below upwards, running under 
and behind the symphasis pubis, from which it is separat- 
ed by loose celular tissue. Its inferior portion is inti- 
mately united to the vaginal walls. Its meatus, the outlet 
for the urine, is situated about an inch from the clitoris, 
and immediately above the prominent enlargement of the 
anterior part of the vagina. 






The Uterus. 65 

internally the urethra opens into the bladder. Its di- 
rection is subject to variation during pregnancy, the blad- 
der being carried upwards with the uterus, the urethra ■ 
curves under the pubic arch, and then ascends perpendic- 
ularly. The same change occurs when the uterus is en- 
larged from other causes. In prolapse of the pelvic vis- 
cera the course is reversed. 

The perineum is the portion between the rectum and 
the vagina. 

THE UTERUS. 

The uterus is the organ provided for the reception, 
growth, and ultimately for the expulsion of the foetus. 
In the virgin normal state it is pear-shaped, flattened from 
before backwards ; is situated in the cavity of the pelvis, 
between the bladder and the rectum, and projects into the 
upper end of the vagina below. ts upper end or base is 
directed upwards and forwards, so that its axis corresponds 
very nearly with that of the superior strait, and forms an 
angle with the vagina. 

The uterus measures about three inches in length, at its 
upper part two in breadth, an inch in thickness, and it 
weighs from one ounce to an ounce and a half. The 
fundus is the upper broad extremity of the organ ; it is 
convex, covered by peritoneum, and placed in a line be- 
low the level of the brim of the pelvis. The body grad- 
ually narrows from the fundus to the neck. Its anterior 
surface is flattened, covered by peritoneum in the upper 
three-fourths of its extent, and separated from the blad- 
der by some convolutions of the small intestines ; the 
lower fourth is connected with the bladder. Its posterior 
surface is convex, covered by peritoneum throughout, and 
separated from the rectum by some convolutions of the 
intestines. The lateral margins are concave, and give at- 



66 Mother, Nurse and Infant. 

tachment to the Fallopian tubes above or superiorly, and 
the round ligaments below ; and behind these, and also 
below the ligament of the ovary. The cervix is the lower 
and constricted portion of the uterus ; around its circum- 
ference is attached the upper end of the vagina, and this 
extends upwards a greater distance behind than in front. 
At the vaginal extremity of the uterus is a transverse 
aperture, the os uteri, bounded by two lips, an anterior 
one which is thick, and a posterior one, narrow and long. 
The os uteri, or os tincae, is generally about the size of a 

Fig. ii Uterus, bladder, etc., showing relative position. 




Fig. ii — Section of pelvis, a, section of pubis ; b, bladder distended ; c, the ute- 
rus in normal position ; e, sacrum ; f, urethra ; g, vagina ; h, hymen ; i, the os 
uteri ; j, meatus of urethra ; k, vagina. 

small goose-quill. The canal of the cervix is from half to 
three-quarters of an inch long ; leading from the os uteri 
it first widens and then contracts again where it enters the 
body of the uterus. The surface of the canal exhibits a 



The Fallopian Tubes. 67 

variable number of follicles or vesicles called the glandula 
nabothi y which secrete a thick mucus ; this blocks the canal 
after impregnation. The cavity of the body and neck has 
a longitudinal extent of about two and a half inches ; in 
virgins it is much less. (Fig. 12). 

STRUCTURE OF THE UTERUS. 

The proper tissue of the womb is composed of fibres, 
and is proved to be muscular. In the unimpregnated 
state it is dense, firm, and of a grayish color. The neck 
appears less firm than the body. 

The internal or mucous membrane is thin, smooth, and 
closely adherent to the subjacent tissue. It is a quarter 
of an inch thick at the middle of the body of the uterus ; 
in the neck it does not exceed one-twenty-fourth part of 
an inch in thickness. It is continuous through the fim- 
briated extremity of the Fallopian tubes with the periton- 
eum, and through the os uteri with the mucous membrane 
of the vagina. 

THE FALLOPIAN TUBES. 

The uterine or Fallopian tubes are two canals, about 
four inches long, placed in the superior border of the broad 
ligaments of the uterus. They extend for about three 
inches and a half, when they expand and terminate with 
a fringed process called the fimbria, which is applied to 
the ovary after impregnation. The Fallopian tubes serve 
the double purpose of a canal for transmitting the fecun- 
dating principle of the male and for carrying the germ 
furnished by the female to the uterus — in fact they are 
excretory ducts of the ovary. 

Injections into the uterus may pass into the peritoneal 
cavity, through the Fallopian tubes, and cause peritonitis. 

At each menstrual period an ovula passes along with 
the serum current in the Fallopian tubes to the uterus. 



68 Mother, Nurse and Infant. 

the ovaries. 

The ovaries in the female are said to be the analogues 
of the testicles in the male ; they both secrete a fluid that 
is essential to impregnation. They are situated on either 
side of the uterus, and are attached to either side of it by 
the posterior duplicative of the broad ligament called the 
ligament of the ovary. (Fig. 12). 

They are oval flattened bodies about an inch and a half 
long, three-quarters of an inch wide at their greatest 
breadth, and a quarter of a inch thick. They are situated 
on the sides of the uterus in that portion of the broad 
ligament called the posterior wing, just behind the Fallo- 
pian tubes. The ovary consists of a peculiar structure 
enclosed by two envelopes, one of which is serous and the 
other fibrous. Within the fibrous coat is a special tissue 
called the stroma ; imbedded in this are numerous small 
round transparent vesicles in various stages of develop- 
ment, varying in size from that of a millet seed to that of 
a hemp seed. They are the ovisacs, containing the ova, 
and are called the Graafian vesicles. These have thin 
transparent walls and contain a clear fluid, and within that 
the ovula. Fifteen or twenty may readily be distinguished 
in the adult female without the aid of magnifying glasses. 

THE VAGINA. 

The vagina is a membranous canal, extending from the 
vulva to the uterus obliquely through the pelvic cavity, 
between the bladder and rectum, having about the same 
direction as the axis of the pelvis. It is described as be- 
ing five or six inches in length and about two inches in 
diameter, but it would be more correct to say that it is 
capable of being distended to these or greater dimensions, 
for in its common state the os uteri is seldom found to be 



The Vagina. 



69 



more than three inches from the external orifice, and the 
vagina is contracted as well as shortened. In great part 
the walls of the vagina are composed of spongy erectile 
tissue, and their vascularity is a cause of considerable 
hemorrhage consequent on their rupture. Three layers 
combine to form the walls; one external or celulo-fibrous, 
a middle or muscular one, and the internal or mucous one. 
The latter is of a pale red hue, which becomes violet dur- 
ing menstruation and especially during pregnancy. The 
mucous coat is disposed in the form of rugae or folds 
anteriorly and posteriorly, which are better developed in 
young virgins and aged females ; during advanced preg- 

Fig. 12— Section of the Uterus, &c. 

a 6 / d. 




Fig. 12— Uterus, ovaries and Fallopian tubes. Section of the uterus, etc. a, Fun- 
dus of the uterus ; b, cavity of the womb ; c, cavity of the neck of the uterus ; 
d, d, the cavity of the Fallopian tubes ; e, fimbriated extremity ; f, f, the 
ovaries ; g, the vagina ; h, h, the round ligaments ; i, i, the ligaments of the 



nancy, and for a short time after delivery, they are entirely 
effaced. 

The upper part of the vagina is connected to the cir- 
cumference of the os uteri but not in a straight line, for 
the former stretches beyond the latter, and being joined 
to the cervix, its mucous membrane is reflected over the 
os uteri, which by this mode of union is suspended with 



70 Mother, Nurse and Infant. 

protuberant lips in the vagina, and permitted to change its 
position in various ways and directions. 

THE EXTERNAL ORGANS. 

The situation of the external organs of generation are 
indicated in the accompanying diagram (Fig. n.) It is 
not deemed necessary here to describe these, but in regard 
to the hymen (the membrane that in infancy nearly closes 
the orifice of the vagina), we may remark that it is not a 
perfect test of virginity. There are, however, examples 
recorded in works on midwifery where a slight surgical 
operation was necessary after marriage, because this mem- 
brane was uncommonly strong. 



CHAPTER III. 

PHVSIOLOGY OF THE UTERUS AND OVARIES. 

Menstruation is a periodical flow of blood having its 
source in the walls of the uterus. But menstruation is 
excited by and dependent upon ovolution, and the effect- 
ive cooperation of both the uterus and ovaries is necessary 
to both menstruation and conception. We shall consider 
these functions separately. 

MENSTRUATION. 

In healthy women at the period of puberty, a certain 
amount of sanguineous fluid is secreted by the lining 
membrane of the uterus, and is excreted through the vagi- 
na every month; this is termed the catamenia, or menses, 
and the function itself menstruation. A female in whom 
the discharge recurs at the usual periods, in the usual 
quantity, and of the usual quality, is said to be regular, 



Menstruation. 71 

The occurrence of menstruation defines the period of 
puberty at which a girl becomes a woman capable of con- 
ception, and its cessation terminates the prolific period of 
female life. 

Dr. Robinson, of Manchester, England, in a paper on 
the natural history of menstruation, has stated the age at 
which it occurred in 450 cases. 

According to his table, 10 menstruated for the first time 
at 11 years of age, 19 at 12, 53 at 13, 85 at 14, 97 at 15, 
76 at 16, 57 at 17, 26 at 18, 23 at 19, and 4 at 20. 

The time at which the first menstruation occurs varies 
exceedingly from the influence of climate, habits of life 
and constitution. There have been occasional instances 
of very precocious menstruation, in which the first ap- 
pearance of the discharge was attended with all the attri- 
butes of puberty. I myself knew one case where a girl 
of nine years, not only menstruated, but presented the 
external signs of puberty, such as prominent breasts, wide 
pelvis, rounded contour of body, &c. 

The first appearance of the menses very rarely occurs 
without being preceded by premonitory symptoms. There 
is usually a degree of languor and lassitude, fatigue after 
exertion, inequality of spirits, dark shade under the eyes, 
headache, sometimes pain in the thyroid gland, pain in 
the back, a sensation of tension and swelling in the lower 
part of the abdomen, and occasionally considerably fever. 
Not unfrequently strange nervous disturbances occur ; 
but all of these symptoms may pass off, the first and sec- 
ond time, without the appearance of the menses, or with 
a white discharge only. Usually the phenomena may last 
from one to eight days, then there is an abundant flow of 
mucus, which after one or two days is mixed with blood, 



72 Mother, Nurse and Infant. 

and soon gives place to almost pure blood. When this 
discharge takes place most of the unpleasant symptoms 
disappear, and the female only complains of weakness 
and is somewhat pale. The hemorrhage continues for 
several days, then the amount of blood mingled with the 
vaginal mucosities diminishes, soon there is mucus alone, 
then the discharge ceases. 

I should remark now that the propriety of applying the 
terms, blood or hemorrhage, to the menstrual secretion is 
properly questioned. 

Sometimes the first menstruation takes place without 
being preceded by any discomfort, but pretty generally 
there is a change in the girl at the time, both in her body 
and mind, a change that fits her for the important duties 
that devolve upon her. 

Most young girls have a return of the discharge after a 
month, the menses afterwards recurring regularly; some 
do not become regular until after several months. Some- 
times the function is imperfectly performed; such cases 
are accompanied with considerable distress. 

In some young girls the precursory symptoms of the 
first appearance of the menses may not be followed by a 
flow of blood, and there is an apparent effort of nature 
recurring monthly for several months before the courses 
become established. 

There are occasional examples of retarded menstruation. 
I am acquainted with one woman who at the age of twen- 
ty-five years has not menstruated. The absence of the 
menses does not render conception impossible, in every 
case. 

After the menses are established, until the time of their 
cessation, they generally return every month, unless inter- 
rupted by pregnancy or nursing. The average of the 



Menstruation. 73 

catamenial period is about twenty-eight days ; in a large 
number it is thirty days ; in some instances they recur 
every fifteen days. 

The duration of the -flow varies from one to eight days; 
three or four days is the most usual duration. The quan- 
tity of blood lost is variable; from three to five ounces is 
said to be the average. 

When the ovaries are congenitally absent, or have been 
removed, or have become disorganized, menstruation is 
absent, or ceases. The cause of the menses is the succes- 
sive evolution of the Graafian vesicles; but the regular 
process may go on in the ovary without the regular san- 
guineous discharge. 

The menses continue in the majority of cases until 
about the age of 46 years, or perhaps in this country 48 
years. 

According to Dr. Robertson, of England, the periods 
at which it closed in 77 individuals was, in 1 at the age of 
35 Y ears > 4 at 40, 1 at 42, 1 at 43, 3 at 44, 4 at 45, 3 at 
47, 10 at 48, 7 at 49, 26 at 50, 2 at 51, 2 at 52, 2 at 53, 
2 at 54, 1 at 57, 2 at 60, and 1 at 70. 

The average duration of the menstrual function is about 
30 years. The cessation of the ovarian function is gener- 
ally announced several years in advance by irregularities 
of the menses. Besides the intermissions and irregulari- 
ties, there are other symptoms ; a general and indefinite 
feeling of uneasiness, pelvic pains, itching at the genital 
parts, flashes of heat in the face, alterations of chilliness 
and perspiration, leucorrhcea, etc. These troubles are usu- 
ally slight, and disappear promptly. The time of life has 
been called the critical period, because there has been 
an opinion prevalent that peculiar dangers attend it. 
However, the mortality is not greater between the ages of 



74 Mother, Nurse and Infant. 

45 and 50 years than at any other period of life. Yet it is 
true that in some instances diseases that had been latent 
previously, declare themselves at this period. 

THE FUNCTION OF THE OVARIES. 

We will now consider the physiological action of the 
ovaries and its intimate connection with the action of the 
uterus in menstruation, etc. 

Preceding the first menstruation an ovary is consider- 
ably enlarged, becomes of a red color, and its vascular ap- 
paratus is considerably congested ; the Fallopian tube 
also becomes congested ; its fimbriated extremity is of a 
violet red color, and has a velvety appearance. The 
Graafian vesicles increase in size; fifteen or twenty of 
them, more advanced than the others, project from the 
surface of the ovary ; one of these grows so that after a 
few days it forms a tumor of the size of a cherry ; the 
walls of the vesicle, being distended by an increased secre- 
tion of fluid, becomes quite thin, and at last are ruptured. 
When the thinned walls give way, the ovule is expelled, 
with a part of the granular contents of the vesicle ; these 
are grasped by the fimbriated extremity of the Fallopian 
tube which is prepared to receive it and convey it through 
its canal into the cavity of the uterus. 

This evolution of an ovule excites numerous sympathies 
throughout the organism of the female, and especially the 
generative organs. The vascular apparatus of the womb 
becomes developed in an unusual manner ; a network of 
fine blood vessels surround the orifices of the numerous 
glandular tubes, of which the membrane is almost entirely 
composed ; this gives a violet hue to the internal surface 
of the womb ; the utricular glands increase in size, the 
muscular structure of the uterus acquires greater exten- 



The Ovaries. 75 

sion, becomes redder and more spongy and supple, the 
volume of the organ is increased, the neck is tumefied 
and its orifice narrower, the lips of the os tincae are warmer 
and their color deeper. 

The vascular congestion which the uterus undergoes is 
accompanied with the exudation of sanguineous fluid, 
which is at first but a few drops ; this communicates to 
the increased vaginal mucus a reddish hue. After a day 
or two there is a bloody flow from the vascular network 
of the mucous membrane. This flow, which constitutes 
the menses, is diminished after three or four days, and the 
discharge again contains a large proportion of mucus and 
serum. It is probable that the rupture of a Graafian ves- 
icle occurs during the last days of the flow, ordinarily, 
and it is also believed that venereal excitement is capable 
of exerting so much influence upon it that it may deter- 
mine the rupture of an enlarged vesicle, which, without 
sexual intercourse, would have remained whole several 
days longer. 

After the discharge of the ovule consequent on the rup- 
ture of the Graafian vesicle, the walls of the vesicle con- 
tract on • the matter that is effused within it, and form a 
compact mass, which after a time has an orange yellow 
color — this is called the corpus luteuvi. 

Ordinarily, in the human female in the normal condi- 
tion, a new Graafian vesicle increases in size every month, 
becomes excessively developed, and finally bursts and dis- 
charges its ovule, to become, through successive transform- 
ations, the corpus luteum. What is called the " monthly 
sickness," "monthlies," "courses," etc., never occurs 
without having been preceded and accompanied by the 
development of a Graafian vesicle. 



CHAPTER IV. 



OF DISPLACEMENTS OF THE UTERUS. 

In order to compress as much as possible what I say 
upon these topics, I shall consider here displacements of 
the uterus, both of those which occur in the pregnant and 
non-pregnant women. 

By the inflection of the peritoneum the uterus is per- 
mitted to expand freely during pregnancy, and to rise 
without inconvenience into the cavity of the abdomen ; 
this it could not do if it was confined to its place by short 
ligaments, or by adhesions. But from the same cause, 
women become liable to various diseases ; to the retro- 
version of the uterus, and other displacements ; to dropsy 
of the peritoneum, and to that species of hernia which is 
occasioned by the descent of the intestines between the 
vagina and rectum. 

By prolapsis is meant that condition in which the 
uterus falls below its natural level in the pelvic cavity. 
Procidentia is a term used to signify the protrusion of 
the uterus beyond the vulva. Women are liable, even 
when young, to a falling of the womb, but it occurs most 
commonly after the age of thirty-five, in such as lead a 
laborious life. Amongst other causes may be enumerated 
violent bearing down efforts, such as are made in strain- 
ing to pass hardened feces, or in urging an evacuation 
through a stricture in the rectum, in coughing, lifting 

heavy weights, etc. 

76 



Prolapsis of the Uterus. 77 

The immediate causes of the displacements are the 
pressure on the uterus by the viscera above it, and a dim- 
inution in tone of the uterine supports. 

Displacements of the womb are more common among 
women who have hollow and capacious pelves ; in suffer- 
ers from dropsy, and in delicate, flabby subjects, where 
the broad and round ligaments are affected and elongated. 

There may be prolapsis during the early months of 
pregnancy, and in cases where the pelvis is large and the 
ligaments are relaxed, the womb may rest on the perine- 
um ; or the neck, and even the body may become visible 
externally ; but it subsequently rises out of the pelvic cav- 
ity, assuming a normal position. 

When a woman has prolapsis uteri she often complains 
of a sense of weight about the pelvis, of dragging pains, 
of a wearisome backache, and of a leucorrhocal discharge. 
Menstruation is seldom interfered with, and as the uterus 
goes back of itself, or is easily pushed up when the patient 
is in bed, conception may take place, and the general 
health may not be directly affected. 

• In some few instances there is complete inability to pass 
water until the patient lies down and replaces the uterus 
with her finger ; in other cases micturition may be an- 
noyingly frequent. Constipation is often complained of, 
and, if the woman be careless, a large accumulation of 
feces may take place in the rectum. 

By a vaginal examination the os uteri is found low 
down, and if the cervix is of the natural length, we know 
that it is prolapsis. 

If a round tumor is seen projecting beyond the vulva, 
and if at the lowest part of it there is what seems to be the 
mouth of the uterine cavity, it may be advisable to intro- 
duce a sound or catheter, to make sure that the opening 



78 Mother, Nurse and Infant. 

is not a mere cleft in a uterine polypus. (Of course, you 
would not use a sound if you suspected pregnancy.) If 
there are ulcers, cracks, etc., they may be detected, the 
ulcers looking as if portions of the mucous lining had been 
punched out. 

In pregnancy, displacements may occur either slowly or 
suddenly, though the woman may have had nothing of the 
kind previously, or they may be the continuation of a pre- 
vious prolapse. The progressive development of the ute- 
rus generally removes the prolapsis about the fourth or 
fifth month, but if the pelvis is very large, it may possibly 
continue. 

As in other cases of prolapsis, the pregnant woman may 
suffer very much from it. She may suffer from a feeling 
of weight at the anus ; painful tractions in the groins, lum- 
ber regions and umbilicus ; a fetid discharge may come 
on ; there may be complete retention of urine, very ob- 
stinate constipation, etc. ; and the pressure on the uterus 
may cause abortion. 

For complete retention of the urine the catheter may be 
used, or the womb may be pressed up by one or two fin- 
gers introduced into the vagina ; or the woman may be 
able to urinate if she lies down and elevates her hips con- 
siderably. 

The operation of introducing the catheter may 
be performed by the educated nurse. The patient being 
placed upon her back and the labia separated, the point 
of the forefinger of the left hand should be placed just 
within the orifice of the vagina so as to press slightly the 
upper edge ; the catheter should then be passed along the 
inner surface of the finger until it is arrested by the an- 
terior part of the vagina ; when there, a very slight move- 
ment so as to elevate the point of the instrument a little, 



Prolapsis of the Uterus. 



79 



enables the operator in the majority of cases to enter the 
catheter into the canal. The operation is more difficult 
when the parts are swollen or distended, as happens occa- 
sionally from disease, during pregnancy or labor, or after 
delivery. If we cannot detect the orifice by the touch, 
we may use a light, and the patient may be placed on her 
side. We may adopt another way to proceed. The point 
of the forefinger finds the clitoris, and passes from above 
downwards to the middle of the vestibule ; the first ine- 
quality met with is the orifice of the urethra, into which 
the instrument can then be passed. It will easily slide in 
if the instrument is not passed either to the right or the 
left of the median line. 

When a woman who has previously suffered from pro- 
lapsis becomes pregnant, it is sometimes necessary for her 
to keep the horizontal position during the first three or 
four months of pregnancy, and after her confinement she 
should keep her bed a considerable time — perhaps for two 
months. 

For the treatment of prolapsis in non-pregnant women, 
the general principles are to be applied : To afford artifi- 
cial support to the superincumbent abdominal viscera ; 
give tone to the broad and round ligaments of the uterus, 
to the vaginal walls and the perineum ; and to remove any 
complications that induce the falling, such as uterine con- 
gestion, hypertrophy, cough, constipation, etc. 

The uterus may usually be easily pushed back to its 
place when the patient is lying down, or, what is better, 
her head much lower than her pelvis. (Fig. 13). The 
knee-chest position is the best one. 

Without going into the details of treatment in the use 
of bandages, tents, etc., I may say that a nurse may, in the 
absence of a physician, use astringent vaginal injections, 



8o Mother, Nurse and Infant. 

astringent pessaries (F. 154, 163), and cold soft water; 
hip baths may also be used. The nurse should know how 
to tamponade the vagina, because, when this is deemed 
advisable by the physician, he desires that the process be 
repeated every day, and in many instances it is not con- 
venient or possible for him to make daily visits. The 
vaginal tampon is used as a means of retaining the uterus 
in its normal position, and also to hold medicinal agents 
applied to the cervix and vagina ; besides, in some cases, 
direct pressure on the pelvic vessels stimulates and thus 
benefits them when in a state of chronic, passive dilata- 
tion, or venous hyperemia. Tampons are also used in 
cases of hemorrhage from the uterus, and as an absorbent 
of vaginal or uterine discharges, and for various other 
purposes. 

The nurse may receive instruction from the physician 
in each case in regard to the material, etc., to be used as 
tampon. When it is desired to simply support the uterus 
in its place, fine cotton batting may be used, and this per- 
haps is, in ordinary cases, as good as any material. But 
in some cases absorbent cotton, oakum, marine lint, or 
wool may be preferred. The size of the tampon will, of 
course, vary ; ordinarily one as large as a hen's egg may 
be introduced without difficulty ; sometimes one nearly as 
large as a goose egg may be necessary, because a small 
one would not be retained. Cotton may be rolled tightly 
into the form of a cylinder, or a small bag may be made 
of muslin or linen, and cotton or other substance can be 
enclosed in this and applied. 

The knee-pectoral position (Fig. 13) is the one in which 
a prolapsed uterus can best be replaced, and the nurse 
can best tamponade the vagina while the patient is in that 



Treatment of Prof apsis. 



8 i 



position. The proper knee-pectoral or knee-chest position 
is shown in Fig. 13. 

The physician would, with or without the aid of the 
nurse, use a Sims' speculum, and first pack four small 
pledgets of cotton around the neck of the uterus. One 
string can be tied in the kite-tail manner around each of 
these pledgets, and there should be an end about ten 
inches long to be left out from the vagina, so that the 

Fig. 13. Genu-pectoral position. 




Fig. 13 — Knee-chest or genu-pectoral position. 

a, Retro-version of the uterus. 

b, Natural position of the uterus. 

whole may be easily removed. The nurse, if alone, how- 
ever, will usually press in but one tampon, and she may 
do this while the patient is in the knee-chest position, or, 
what is nearly as well, on her side or back, having first, by 
a digital examination, ascertained that the uterus is in its 
proper position. 

Either the nurse or the patient herself may easily press 
a tampon into its proper position, if she possesses an ordi- 
nary amount of boldness and dexterity. She will find it 
more difficult to properly place it, however, if there is tan- 



82 Mother, Nurse and Infant. 

nin or other astringent substance on the outside of it. 
This has an astringent effect immediately when it comes 
in contact with the vagina, and an unusual amount of vas- 
eline is necessary to cover it. 

If a solution of tannin, alum, acetate of lead, sulphate 
of zinc, or carbolic acid be used, it is best to prepare sev- 
eral tampons at the same time ; soak all the tampons in 
the solution, squeeze them out and dry them, then when 
one is used put it inside a bag and apply it dry. 

The patient herself, if she is intelligent, and is not too 
timid, can introduce the tampon. She should first smear 
its surface with vaseline, lard, or olive oil. Then lying on 
her back with thighs separated and flexed, draw the labia 
apart with the fingers of one hand and steadily crowd the 
tampon into the vagina with the other, always taking care 
to have a good, strong cord, one end attached to the tam- 
pon and the other hanging down to facilitate removal. 

It is well also, sometimes, to place another pledget of 
cotton between the labia, that can be removed when the 
woman urinates. When all is well crowded into place, 
the tampon should be retained by a broad T bandage, 
covered by oiled silk when it rests against the vulva. 

Generally the whole should be removed within from 
eighteen to twenty-four hours, and hot water or some 
cleansing injection used, and the tampon be soon reap- 
plied. 

If opium or morphine is used with the tampon, as it is 
sometimes when there is considerable pain, first dip the 
cotton in glycerine, and then sprinkle the narcotic on the 
outside. 

If borax, tannin, alum, acetate of lead, sulphate of zinc, 
chlorate of potash, or carbolic acid is used, I think it well 
to envelop the undissolved drug in cotton, put it in the 



Displacements of the Uterus. 83 

middle of the tampon, and let it dissolve slowly in the 
vagina. It is best when thus applied to let the whole sup- 
pository remain as much as forty-eight hours ; it should, 
however, be removed when it seems to cause smarting or 
excoriations. 

The accompanying cut (Fig. 13) is inserted to show 
what is the knee-chest or genu-pectoral position, as well 
as to exhibit the retroversion of the uterus. Note that in 
this position the hips are elevated, and remember that it 
does not suffice to get on the hands and knees if the 
haunches are low down on the legs and ankles. 

RETROFLEXION AND ANTIFLEXION. 

The condition known as retroflexion consists of a bend- 
ing back of the uterus at a point where the neck joins the 
body, so that the fundus is found between the cervix and 
rectum, the os uteri being in the natural position. 

Fig. 14. Retroflexion of the uterus. 




In anti flexion we find the fundus pressing upon the 
bladder. These displacements are rare in virgins. The 
false membrane formed in peritonitis is now and then the 
cause of these deviations, when there is superadded such 



8 4 



Mother, Nurse and Infant. 



causes as are mentioned for prolapsis. The symptoms of 
retroflexion are usually a dull, weary and constant 
backache, which is more marked about the sacral region, 
pains that shoot down the thighs or the groins, and a fre- 
quent desire to go to stool, although nothing comes away. 
The passage of a motion that is not at all constipated ag- 
gravates the pain and aching ; sexual intercourse is at- 
tended with suffering, and is not followed by pregnancy ; 
and just before and after the monthly periods there is so 
much tenderness that sexual connection cannot be tol- 
erated. 

The catamenia come on with pain and difficulty, but 
about the second day the flow of blood seems to give some 
relief. The general health is bad, there are frequent at- 
tacks of nausea, the appetite is small, the spirits are de- 
Fig. 15. Anteflexion of the uterus. 




pressed, and there are many what are called hysterical 
symptoms. On examination the congested fundus may be 
found encroaching upon the rectum ; on touching this 
part the patient will exclaim that it is the seat of her suf- 
ferings, and it is not uncommon to find tenderness of one 
or both ovaries. 



Anteversion. 



85 



Not many of these symptoms are present in anteflex- 
ion, but this commonly produces great irritability of the 
bladder, so that when the patient is in the erect position, 
the desire to micturate is almost as great as in disease of 
the bladder. 

The treatment includes replacing the uterus with the 
sound. Should there be adhesions, however, this might 
cause intolerable pain. In such cases relief is given by 
the use of belladonna plasters and belladonna, opium, 
hyoscyamus, or conium tampons. One-half to one dram 
of the tincture of one of the narcotics may be added to 

Fig. 16. Anteversion of the uterus 




the glycerine in which the tampon is soaked, or the cervi- 
cal end of the tampon may be dipped in the tincture. 
Suppositaries and ointments may also be used. (F. 153, 
199). 

RETROVERSION AND ANTEVERSION. 

In retroversion (Fig. 13) the fundus is turned toward 
the hollow of the sacrum, while the os is drawn under the 
arch of the pubis. 

Anteversion is characterized by the fundus being to- 



86 Mother, Nurse and Infant. 

wards or against the bladder, the os being directed to the 
cavity of the sacrum. (Fig. 16.) Retroversion is liable to 
occur at the third month of pregnancy, from the neglect- 
ed distention of the bladder, and from a morbid weight 
and enlargement, though after the fourth month the ute- 
rus is too much enlarged to fall down in any way. The 
chief symptoms are backache and bearing down pains. 
It may happen that micturation will be impeded ; and if 
the bladder may be felt at the lower part of the abdomen, 
or if the patient complain of a constant desire to pass 
water, or especially if the urine should dribble away, the 
catheter ought to be passed without loss of time, and the 
bladder should be kept evacuated. It may be necessary, 
in order to restore the organ to its proper position, to in- 
troduce the first and second fingers of one hand into the 
vagina, and a finger of the other into the rectum. 



CHAPTER V. 

MlSMENSTRUATION. 



AMENORRHEA. 

The first variety of cases of amenorrhcea are those 
where no menstrual fluid has ever been secreted. All 
girls, as we have seen, do not menstruate at fifteen years, 
as all children do not cut their first teeth at seven months, 
and in either case there may be no disease. But when a 
female has reached adult life, when her frame has assumed 
the character of womanhood, when she is not chlorotic, 
and when all her organs (save the sexual) perform their 
functions naturally, then a cause of the absence of the 
flux should be looked for. Menstruation may be absent 
from congenital malformation. The ovaries may be want- 
ing, or if present may be atrophied or diseased ; perhaps 
they present scarcely a trace of a Graafian vesicle ; or 
these glands can exist and the uterus be absent or imper- 
fect ; or there may not be found a trace of a vagina. In 
the second variety of amenorrhcea there has been a secre- 
tion of the menses but no evacuation of them. This 
may be because there is an occlusion of the vagina, or the 
os uteri may be imperforate. When the os is closed by a 
membrane, the structure may be incised with the bistoury, 
or perhaps be ruptured by the uterine sound. 

The third variety is the most common form of amenor- 
rhcea, viz : that in which the flux having been properly 

87 



88 Mother, Nurse and Infant. 

established and appearing regularly for a time, has been 
prematurely arrested. But it may be said of amenorrhoea 
in its various forms, that it is not so much a disease as a 
symptom of disease ; a consequence of either individual 
organization, disorder of the uterus or ovaries, or of some 
other organ or organs sufficiently important to affect the 
constitution. 

Hence all the means that restore the system to health, 
medicinal and hygienic, may be recommended as tending 
to cure the complaint, and hence we have to inquire 
whether there is serious disease in any of the organs when 
the question of pregnancy arises, on account of the dis- 
appearance of the menses. 

It is always necessary in treating amenorrhoea to con- 
sider the cause of it, and we should know that it may 
come from torpitude of the secernent vessels of the uterus, 
produced by anxiety of mind, cold, or suddenly suppressed 
perspiration ; falls, especially when accompanied with ter- 
ror ; or a general inertness and flaccidity of the system, 
and more particularly of the ovaries. (F. 201, 202). 

DYSMENORRHCEA. 

There are few women who pass through the whole peri- 
od of sexual vigor without having more or less frequently 
to endure an attack of dysmenorrhcea. Some few females 
experience great pain with each flow, from puberty to the 
change of life, while in others pain is only an exceptional 
accompaniment. With some women marriage effects a 
cure, while in others it either aggravates or originates dys- 
menorrhcea. Three distinct varieties of dysmenorrhoea 
have to be considered : the neuralgic, the congestive, and 
the mechanical. 

The variety which is called neuralgic dysmenorrhcea = 



Dysmenorrhea. 89 

is more frequent in unmarried females ; and if married, in 
those that have not borne children ; and most frequently 
affects those of a nervous temperament, and of a thin, del- 
icate habit. The paroxysms present all. the characteristics 
of neuralgia. For a time before the catamenia appear 
there is a sense of general uneasiness, a deep-seated feel- 
ing of cold and headache, sometimes alternating with pain 
in the back and lower part of the abdomen, perhaps ex- 
tending down the thighs. 

The flux comes on sometimes slowly and scantily, or in 
some cases in slight gushes. The discharge may be paler 
than natural, and may be mixed with slight clots. In 
some cases there is a membrane of plastic lymph discharged 
either in shreds, or in the form of the uterine cavity that 
it has lined. Conception is rare under such circum- 
stances. 

Though the disease seems to be of a simple neuralgic 
character, it is supposed that there is a degree of inflam- 
mation of a peculiar kind in the mucous membrane where 
the plastic lymph is thrown off, 

In regard to the duration of the period, the constitu- 
tional injury sustained, and as to the relief on the appear- 
ance of the menses, the cases vary. 

A peculiar irritability of the uterus is a common cause 
of this form of the disease, but, like amenorrhcea, it may 
be caused by cold, mental emotion, or local injury from a 
fall. 

In the treatment of this class of cases, to reduce the 
pain, opium, conium, hyoscyamus, etc., are given, often 
combined with camphor. (F. 161, 163, 166, 167.) These 
should be given in the form of an enema, or a suppository, 
if the stomach is irritable. (F. 160.) The hot hip bath 
should be employed, the patient remaining in it from thir- 



90 Mother, Nurse and Infant. 

ty-five to forty minutes ; an ounce of carbonate of soda 
may be added to the water. The good effects of the 
bath may be kept up by the use, immediately afterwards, 
of a pessary of oxide of zinc and belladonna. (F. 162.) It 
will be of benefit to take vaginal injections of tepid, or 
warm, or hot water on the approach of the menses, and 
the patient should use a pediluvium, or a hip bath, for two 
or three nights in succession antecedent to the show 
of the menses. During the interval every effort should be 
made to strengthen the patient, and to diminish the irrita- 
bility. Injections of tepid or cold water may be taken 
daily ; the diet should be nourishing, and plenty of exer- 
cise in the open air should be taken by the patient. Some 
preparation of iron should be given, and I have found F. 
177 particularly useful. 

Congestive dvsmenorrhcea, sometimes described as 
inflammatory dvsmenorrhcea, generally comes on at a later 
time of life than the neuralgic form. It occurs in females 
of a full habit and of a sanguine temperament ; in the mar- 
ried as well as the unmarried, and those that have not 
borne children. 

Restlessness and feverishness, rigors, flushing and head- 
ache generally precede the severer symptoms. The suf- 
ferings commence, or are generally aggravated four or five 
days before the period, and it may continue for a week or 
more. Both before and after the catamenia appear, there 
is great pain across the back, aching of the limbs, intoler- 
ance of light and sound, weariness, the face is flushed, the 
skin hot, the pulse full and bounding ; when the flow gets 
abundant the pain is mitigated, though there are parox- 
ysms of pain, as small clots and shreds of membrane are 
thrown off from the uterine cavity. Under the influence 
of inflammation, the epithilial coat of the uterine cavity 



Dysmenorrhea. 



9i 



and of the vagina is sometimes expelled. In the interim 
between the periods the cervix uteri is congested and ten- 
der, and pain will be excited by pressing the ovaries ; usu- 
ally there is a tenacious leucorrhaeal discharge. Frequent- 
ly the breasts swell and become tender as the period ap- 
proaches. 

In treating this form of dysmenorrhcea, opiates must be 
used, as in the former variety, to afford some alleviation. 
Give also saline purgatives, febrifuge medicines, such as 
aconite, veratrium, and gelsemium ; also cooling drinks. 
During the interval the patient should live plainly, avoid 
stimulants, and take moderate outdoor exercise. The 
suppositories (F. 163) may be used steadily. If the dis- 
ease be associated with a rheumatic diathesis, the appro- 
priate remedy for that should be used. It is in such cases 
especially that chalybeate mineral water, warm sea water, 
baths, colchicum, iodide of potassium, with friction and 
electricity applied directly to the hypogastric region, suc- 
ceed in restoring health. (F. 103, 165). 

Mechanical dysmenorrhcea is that form in which 
there is some mechanical obstruction to the escape of the 
menstrual discharge. The causes of the obstruction are 
various. There may be either a stricture of the internal 
orifice of the uterus, or a narrowing of the whole canal of 
the cervix, or the external os uteri may be small and con- 
tracted, or some tumor may interfere with the patency of 
the cervical canal, and there may be retroflexion or anti- 
flexion of the uterus. 

In these cases there is more or less violent expulsive 
pain coming on in paroxysms, and there is usually a scanty 
flow. Often the discharge escapes in gushes, each gush 
being preceded by a bearing down effort, and accompan- 
ied by an expulsive pain. There are attacks of nausea, 



92 Mother, Nurse and Infant. 

restlessness and retching, with flatulence ; there is always 
severe headache and congestion, with tenderness of the 
ovaries ; and if there is endometritis, there are some other 
inflammatory symptoms. 

Modern gynecology has various remedies for this class 
of cases, of which it is not necessary to speak here. 

MENORRHAGIA. 

The term menorrhagia should be applied only to cases 
of menstrual flow, although it is often employed to signify 
any considerable sanguineous discharge from the uterus, 
other than normal monthly escape. But I will say some- 
thing here of cases where there is a more abundant or a 
more prolonged flow than is natural to the subject of it, 
and of cases where there is a recurrence of the discharge 
at short intervals, so as to seem almost continuous. 

In that variety in which the discharge is normal in qual- 
ity but the quantity is increased, there is undue uterine 
congestion, set up by constitutional causes, or it is induced 
by slight disease of the uterus or ovaries. 

When menorrhagia takes place in plethoric habits, it is 
manifestly remedial, and ought not to be restrained hast- 
ily. We may endeavor to reduce the plethora, and a cool- 
ing diet, the recumbent position, and saline cathartics 
may be enjoined. (F. 61). 

If the flow continues five days or more, and especially 
if depressing effects are manifested, such as general weak- 
ness, languor, mental depression, with pain in the head, 
loins or back, the patient is undoubtedly suffering from 
the loss of blood, and it is best to restrain the flux by gen- 
eral and local means (F. 176.) At the time when the flow 
is profuse or long continued, give strong cinnamon tea, a 
teacupful at a time, or teaspoonful doses of tincture cin- 



Generation. 93 

namon every hour. Astringent pessaries should some- 
times be used. Formerly injections of cold water were 
given ; recently injections of hot water, as hot as can be 
borne in the vagina, are considered more effectual. Fluid 
extract of ergot, in half-teaspoonful doses, may be given 
every hour for two or three successive hours. Other rem- 
edies are elixir vitriol and turpentine, opium and acetate 
of lead during the attack ; and counter irritation to the 
sacrum, the douche to the loins, sponging, cold vaginal 
injections, and the sitz bath during the interval. (F. 175). 
If astringent or cold injections are used, the patient 
should lie upon her back in bed, and the fluid should be 
thrown up gradually. Of course, there are cases where 
only an experienced, well-educated physician can do all 
that is required in removing the cause of the difficulty. 



CHAPTER VI. 



GENERATION. 



Generation is effected in the human species through 
the medium of the two sexes ; to effect it there must be 
the actual contact of the male semen or its spermatozoa, 
with a healthy Graafian vesicle. 

In conception the spermatic fluid is furnished by 
the male. When this is examined under the microscope 
it exhibits a great number of little bodies, which afe mov- 
ing ; these are termed spermatic animalcules, or sperm- 
atozoa. These are met with in all animals capable of re- 
production, and they do not appear in the human species 
before puberty. 

The ovule furnished by the female is existent in the 



94 Mother, Nurse and Infant. 

ovary at the marriageable period. Fecundation takes 
place in the ovary ; probably, sometimes, also in the tube 
or uterus when the ovule is passing out after menstruation. 

Ordinarily the fluid ejaculated by the male must reach 
the uterus, and in some way be conveyed to the ovaries 
through the Fallopian tubes to produce fecundation. 

It is believed that, as the consequence of copulation, 
the semen is thrown on the neck of the uterus ; that it is 
carried forward, first, by the movements proper to the 
uterus and tubes ; second^ by the movements proper to 
the spermatozoa till it reaches the ovum, generally in the 
ovary ; that it enters the ovum, and that then fecundation 
takes place. 

Upon being impregnated and the vesicle bursting, the 
ovum is grasped by the free extremity of the Fallopian 
tubes, which is in contact with the ovary, the ovum 
passes from the ovary to the canal, is pressed onwards 
by the peristaltic motions of the tube through the duct, 
and finally reaches the uterine cavity ; there it continues 
to grow during the ordinary term of gestation. After two 
hundred and seventy days the ovule has developed into a 
child, and is expelled through the natural parts of gener- 
ation. When gestation proceeds in this manner, it is said 
to be normal, or good, or uterine ; sometimes (though 
very seldom) the ovule is arrested at some point in its 
passage, and is developed outside of the womb ; this is 
termed an extra uterine pregnancy. 

The time at which conception is most likely to occur is 
that immediately following the flow of the menses ; it may 
take place immediately before the flow, and sexual inter- 
course may be fruitful even when it takes place in the 
middle of the interval between the sexual periods, though 
the latter is unusual. 



Utero- Gestation. 95 

When conception takes place a few days or a few hours 
before the period, it is not followed by the menstrual flow. 

UTERO-GESTATION. 

At each menstrual period the bulk or size of the uterus 
is for the time increased, and if conception takes place 
about that time, the excitement maintains and soon in- 
creases the enlargement. The mucous membrane be- 
comes almost doubled in thickness, and when the ovule 
arrives in the womb, it finds it filled with the membrane, 
the whole uterus is congested, its vessels enlarge, and are 
filled with blood, many which were invisible before are 
now filled with red blood, and the whole form an intricate 
net-work on the surface, and in the substance of the or- 
gan ; the coats of the arteries increase in thickness ; the 
coats of veins are thinner, and admit of still greater dis- 
tention ; the nerves increase in size, and may be seen ac- 
companying the blood-vessels, and there are changes not 
only in the volume, but in the shape, situation, direction, 
and relations of the uterus. 

The organ increases slowly in size during the early 
months of pregnancy, and more rapidly in the later. The 
walls are distended, however, not mechanically from the 
development of the ovum, but simultaneously with it, and 
from a physiological cause ; in shape it becomes rounder, 
and towards the end of pregnancy it has an ovoid form. 
Simultaneously there is an alteration in its position ; at 
first the neck subsides towards the floor of the pelvis ; the 
presence of the rectum may incline the fundus to the 
right and the neck to the left ; about the fourth month 
the uterus rises above the superior strait ; at four months 
the fundus uteri is two or three fingers in breadth above 
the pubis ; at five months it is within one finger's breadth 



96 Mother, Nurse and Infant. 

of the umbilicus ; between the fifth and sixth month it 
passes the umbilicus ; at seven months it is three fingers' 
breadth above the naval ; at eight months it is four or five 
above, but it does not rise higher during the last month. 
While it is rising it follows the direction of the axis of the 
superior strait ; afterwards it inclines to the right oftener 
than to the left. 

At term, the superior part of the uterus is in contact 
with the abdominal walls usually, but sometimes there may 
be some of the intestines interposed between them. 

At full term the parietes of the womb are thicker than 
in the unimpregnated condition ; at the point correspond- 
ing to the insertion of the placenta, thinner at the neck, 
and otherwise it retains about its original thickness. 

The uterus increases about forty times in weight during 
pregnancy ; at term it weighs about twenty-four ounces, 
and its length is from twelve to fourteen inches, its breadth 
from nine to ten, and its depth, antero-posteriorly, eight 
to nine inches. 

The os uteri, after it is in the gravid state, becomes 
somewhat swollen, but soft and cushion-like. This soft- 
ening is at first superficial. Towards the end of the third 
month, the lips of the os tincae are softened throughout 
their whole thickness, and the softening increases from 
below upward. 

The neck of the uterus seems somewhat elongated at the 
first, but at the commencement of the sixth month the 
length of the cervix seems to diminish ; there is, however, 
no considerable shortening until the middle of the eighth 
month ; during the last fortnight of pregnancy it dimin- 
ishes very rapidly, and finally is totally effaced. 

In primapara the os tincae is rounded at first, and is 
not dilated. In females that have had children the ex- . 



Utero- Gestation. 



97 



ternal orifice is widely open, and the cavity in the neck is 
funnel-shaped, continuing to increase until it reaches the 
internal orifice. 

As gestation progresses the texture of the uterus changes. 
The peritoneum spreads out in all directions without a 
decrease in thickness ; the mucous coat becomes appar- 
ent, it grows redder and more vascular, and its folds dis- 
appear ; the glands of the body of the womb grow longer ; 
the middle coat is enlarged by the increase in size of al- 
ways existing muscular elements, and the formation of 
new fibres and increased connective tissue. There is, 
towards the end of pregnancy, an astonishing develop- 
ment of the vascular system ; the lymphatic vessels ac- 
quire considerable calibre, and the nerves are developed 
in every way, although the neurilema is most affected. 

The changes developed in the uterine mucous mem- 
brane are of especial interest. Its vasularity is greatly 
increased during menstruation, the glands are enlarged, 
the membrane thickened, thrown into folds and becomes 
of a violet color ; this condition continuing until the ovule 
is discharged, or until the last of the menstrual period. 
The fecundation of the ovum will maintain and increase 
this vascular condition of the membrane. Its vessels are 
so enlarged as to cause small effusions beneath the epithe- 
lium, which gives to the internal surface a spotted ap- 
pearance ; after two or three weeks it is still more mottled, 
more puffed up, and furrowed with folds and wrinkles. 
This membrane is the decidua, which is afterwards expelled, 
with other contents of the uterine cavity. 

The decidua reflexa is a fold of -the decidua in which 
the foetus is enveloped, and both of these membranes, 
which are at the last expelled with the foetus, are devel- 
oped from the uterine mucous membrane. The uterine 



98 Mother, Nurse and Infant. 

decidua, after the second month, grows thinner, and its 
folds are gradually effaced ; after the fifth month it is only 
one twenty-fifth of an inch in thickness, and it is still 
thinner at the termination of pregnancy. At the fifth 
month it is separable from the uterus, and the first trace 
of the new membrane which is to replace the decidua may 
be detected under it. A partly uterine membrane may be 
thrown off when an abortion occurs, during the early 
months of pregnancy. 



CHAPTER VII. 

THE OVUM AND ITS DEVELOPMENT. 

The ovum at maturity (and not impregnated) is de- 
scribed as being composed of the vitelline membrane, 
which seems like albumen in appearance, but is a thick, 
transparent membrane, without determinate texture ; sec- 
ond of the vitellus or yolk, a granular liquid contained in 
the vitelline membrane, composed of a coherent trans- 
parent viscid mass ; third of the germinal vesicle, which 
is composed of a transparent colorless membrane, enclos- 
ing a liquid also transparent ; and lastly, of the germinal 
spot, that is held in suspension in the liquid that the germ- 
inal vesicle contains. 

The ovum passes slowly through the Fallopian tubes, 
and during the twelve days or more that it is passing to 
the uterus, there is some development, some increase in 
size, and by the time it has reached the uterus it has be- 
come impossible to find in it either vesicle or germinal 
spot. 



The Ovum. 



99 



It is probable that in its passage it is nourished by the 
granulations which accompany it, and by absorbing the 
liquid secreted by the oviduct. 

As the impregnated ovum is developed, the chorion, the 
amnion and the embryo may be observed. 

The chorion, which corresponds to the membrane lining 
in the shell of an egg, is found covering the ovum at the 
earliest period that it has been seen in the uterus. It is 
smooth internally, but externally it is covered with short 
round villi, which at a later period remain only where the 
placenta is developed. The chorion is enveloped in a 
great measure by the reflected decidua ; there is at the 
outset considerable space between the two, mostly filled 
at first by the villi of the chorion, though there may be be- 
tween the two an effusion of blood ; these villi soon disap- 
pear, and the membranes come in contact. 

In that part of the chorion that is not covered by the 
. decidua reflexa, the villi are more and more developed, 
and they contribute a most important part in the forma- 
tion of the placenta. 

At the same time that the placenta is formed, the villi 
on the other portion of the chorion is obliterated, so that 
the principal part of the chorion is a thin, colorless, trans- 
parent membrane, united outwardly to the reflexed de- 
cidua by short, delicate filaments, and inwardly to the 
amnion by an albuminous layer called the tunica media. 

There is also between the two membranes the vesicula 
alba. This bears a perfect analogy to the yolk of an egg ; 
it is the vitellus surrounded by the blastoderm. Its use 
is to contain nutriment for the foetus before the develop- 
ment of the placenta. 

The amnion is the most internal membrane of the ovum ; 
it is continuous with the margins of the ventral opening 



ioo Mother, Nurse and Infant. 

in the foetus, and closely envelopes the embryo in the 
early period. Its internal surface exhales a liquid into its 
own internal cavity, and in this the embryo swims freely. 

As this membrane is more and more filled, it presses 
back the exterior liquid and thereby condenses it until the 
amnion comes in contact with the chorion. And since it 
adheres to the abdominal parietes of the foetus, it fur- 
nishes as it extends a membranous sheath to the alantoid 
and umbilical vesicle, and these vessels, and all parts thus 
enclosed constitute the umbilical cord. 

The placenta is an appendage of the chorion ; it is a 
soft, spongy mass, constituting the principal connection 
between the ovum and the uterus, being destined to the 
hemetosis and (as we suppose) to the nourishment of the 
foetus. The placenta, at the termination of utero gesta- 
tion, is a flattened body about an inch in thickness at the 
center ; its shape is circular or oval, and it is from six to 
eight and one-half inches in diameter ; its internal surface 
is covered by the chorion and amnion, and exhibits plainly 
the umbilical arteries and veins which converge to form 
the umbilical cord. Its foetal portion is formed by the 
hypertrophied villi of the chorion, with which its circum- 
ference is continuous, and its maternal portion is continu- 
ous with the decidua, and is in fact a thickened part of 
that membrane. As the villi of the chorion are developed 
on one part of its surface, they ramify and form filaments 
that engraft themselves upon the uterine mucous mem- 
brane and adhere closely. At the same time there is an 
inverse development of the uterine vessels, which form 
vast numbers of loops that descend between the villi of 
the chorion, and extend through to the fcetal surface of 
the placenta. An amorphous matter is soon thrown out 
which unites the two parts together. 



Development of the Placenta. iot 

The placenta is, therefore, composed of two parts, dis- 
tinct in their physiological action, though they together 
present but one mass to our view. One part is the fcetal 
portion formed from the chorion ; the other is the mater- 
nal portion formed from the uterine mucous membrane, of 
which it is a greatly thickened part. After delivery the 
fcetal placenta comes entirely away with the epithelial 
layer of the placental decidua, and the placental distribu- 
tion of the maternal vessels ; a portion of the maternal 
vessels remains attached to the uterus. 

The placenta may be inserted upon any part of the 
uterine cavity, although it is most usually near the fun- 
dus where the ovum must enter the womb. If, as is 
sometimes the case, it is attached at the lower part, over 
the orifice of the womb, it causes unavoidable hemorrhage 
in the later months of pregnancy. 

The umbilical cord, funis, or naval string, is the connect- 
ing link between the child and mother. It commences 
when the external lamina of the blastoderm with the alan- 
tois are so changed as to form a mere cord upon which 
the two umbilical arteries ramify, and when all these have 
an enveloping sheath from the amnios. It may be dis- 
cerned in this state at the end of the first" month ; at that 
time the fcetal intestines may be seen to protrude beyond 
the umbilicus into the amnionic sheath, but the cord is 
then cylindrical and very small. There are progressive 
changes, the cord becomes simplified, the canal of the 
amnionic sheath is obliterated gradually at its extremity, 
and as the effacement proceeds towards the umbilicus the 
intestine is pressed back so that no hernia remains. 

There are two arteries in the cord; these arise from the 
abdominal aorta in the foetus ; they go by a flexed and 
tortuous course to the placenta, where they ramify and 



102 Mother, Nurse and Infant. 

are distributed. There is only one vein which returns the 
blood from the placenta ; there the radicles coalese to 
form the branches; these unite to form the umbilical vein. 
This is not as flexuous as the arteries, which, being longer, 
wind around the one venous trunk. After the third 
month these may be plainly seen in the sheath imbedded 
in what has been called Wharton s gellatine. 

Ordinarily the cord lies free and loose in the cavity of 
the amnion, but occasionally owing to the movements of 
the child it may be coiled around the child's neck, be tied 
in knots, or it may escape below the head so as to prolapse 
during labor. 

The length of the cord varies; it is very rarely less than 
eight inches, and it is sometimes six or eight feet long. 

After the birth of the child, the pulsation in the cord 
ceases within about fifteen minutes. After the cord is 
cut that portion that is attached to the umbilicus dies and 
usually falls off about the fifth day. 

The blood of the foetus is aerated or undergoes a change 
in the placenta analagous to the change that our blood 
undergoes in the lungs. 



CHAPTER VIII. 



THE FCETUS. 



The embryo first begins to be distinct about the third 
week ; is then about two lines long, weighing one to two 
grains ; is surrounded by an amnion which lies loosely 
about it, and obviously proceeds from the abdominal 
laminae ; it presents cerebral vesicles ; there is the appear- 
ance of an eye, several arteries are seen though not dis- 
tinctly formed ; the abdominal cavity is open for a con- 
siderable extent in front. 

About the fifth week the embryo becomes more consist- 
ent; the head is disproportionately large; rudimentary 
eyes are indicated by two black spots ; the abdomen is 
nearly closed, though at the umbilical aperture a loop of 
intestine escapes ; the abdominal members are present, 
and the cord exists in a rudimentary condition; the em- 
bryo is nearly two-thirds of an inch long and weighs about 
fifteen grains. 

The successive changes in the development were, ist, 
a germ membrane visible immediately after the bursting 
of the vesicle ; 2d, at some point an aggregation of gran- 
ules forming the cumulus of the blastoderma ; 3d, the 
embryo developed lying at this point, as it were upon the 
membranes, which consist of three superimposed laminae 
or layers ; 4th, on the serous layer arise the organs of 
animal life, the brain and spinal marrow, organs of sense, 
skin, muscles, tendons, ligaments, cartilage, and bone ; 



104 Mother, Nurse and Infant. 

on the mucous the organs of vegetative life, the intestinal 
canal, lungs, liver, spleen, pancreas and other glands. 
The heart and vascular system arise from the vascular 
layer (if this can be considered a separate one). 

About the second week, or perhaps the third, there is a 
mass of globules loosely connected together forming the 
primitive streak of Von Baer, and around this the area 
vasculosa is developed. The globules of the primitive 
streak, seem next to be developed into two laminae dor- 
sales, which is the axis of the future embryo, and the origin 
of the spinal column. That portion of the fluid that sep- 
arates the chorda dorsalis from the lamina dorsalis is the 
future spinal cord, and brain. Two other lamina — laminae 
ventrales of Von Baer — are in the mean time proceeding 
from the axis of the embryo, one on each side; they grow 
laterally and converge below the axis. 

After the rudiments of organic life have been com- 
menced in the central portion of the serous layer, a fold 
of its peripheral portion arches over the dorsal surface of 
the embryo so as to represent a sac, and is composed of 
two membranes; the one next to the foetus is the amnion, 
the other is gradually separated from the amnion and 
joins the serous lamina of the blastoderma; this is the 
false amnion of Pander. 

The heart is formed at this early period, and although 
there is no septum between the ventricles, a vein may be 
seen entering into it, and an artery passes out which di- 
vides into four branches to be distributed and ramified in 
different portions of the foetus. 

The abdomen is yet an open cleft, in which (but pro- 
jecting beyond it) is the heart, which is of very large di- 
mensions ; behind the heart is the liver, and under the 
liver the intestine which is attached by means of a distinct 



The Embryo. 105 

mesentery. At this period (three weeks) the lungs are 
constituted of five or six lobules, and two large glandular 
structures may also be discerned along the vertebral col- 
umn, which are called Wolfian bodies ; these anticipate 
the function of the kidneys. The alantois is seen arising 
from the lower part of the intestinal canal on a little vesi- 
cle and extending so as to encircle the embryo. 

During the second month the extremities are growing, 
and become more projecting ; the body is curved and the 
head bent downwards ; there are indications of the nos- 
trils and a gaping oral aperture ; the forehead is more 
swelled because of the development of the hemispheres of 
the brain ; the spinal cord is cylindrical of nearly uniform 
thickness and terminating in a blunt extremity — posteri- 
orly it is open ; the medula oblongata makes a bend for- 
wards at the top of the neck, and then ascends perpen- 
dicularly into the capacious cranium. 

The first centres of ossification appear about the sev- 
enth week on the clavicle and lower jaw. At this time 
the kidneys and renal capsules begin to appear. The 
only trace of muscular fibre is in the diaphragm. The 
vertebral arches are not yet closed in, and the ribs appear 
like little streaks ; the liver is very large and granular. 
The stomach is assuming somewhat of its normal form ; 
the urinary bladder is enclosed, but the anus is imperfor- 
ate. At this time the embryo is about an inch in length. 

At two months the rudimentary organs of generation 
may be distinguished, but their development does not 
clearly show the sex. The embryo is from one and a half 
to two inches long and weighs near half an ounce, the 
head forming two-thirds of the whole. 

After this period the different parts are developed with 
tolerable rapidity. At ten weeks the embryo is about two 

*7 



io6 Mother, Nurse and Infant. 

and a half inches in length. At the end of the third month 
it is from five to six inches long and weighs from three to 
four ounces. The thorax is closed at all points but is 
only slightly developed ; the cord contains no intestines, 
and its spiral turns are evident ; the nails are beginning 
to appear ; the sex is distinct, and the skin acquires some 
consistence. At the fourth month the foetus is six to 
eight inches in length, and weighs from seven to eight 
ounces. A foetus born at this period might live for an 
hour or two. At five months the length of the body, in- 
cluding head and feet, is from eight to ten inches, and 
weighs from eight to eleven ounces ; at six months the 
weight is about one pound, and the length is eleven to 
twelve and a half inches. 

At seven months the foetus is from twelve and a half to 
fourteen inches long and weighs from three to five pounds. 
The hands' and feet, including the nails, are developed ; 
all its parts are tolerably firm, and their respective dimen- 
sions better proportioned than formerly. The scrotum 
usually contains one or both testicles, they having de- 
scended through the inguinal ring, from their original 
place near the vertebral column ; the eyelids are partly 
open ; the skin is very red and covered with down. 
Many children live and are reared that are born at seven 
months. 

The length of a foetus born at term is eighteen or nine- 
teen inches, though the utmost limit is more than two 
feet. The usual weight is from six to seven pounds ; 
children have been born, however, that were as much as 
eighteen pounds in weight. I suspect that this will never 
occur unless the term has been extended beyond the usual 
period. 

At term the foetus that is twenty inches long will gen- 



The Fcetus. 107 

erally measure ten and a half to eleven inches from the 
crown to the umbilicus. The different parts are well 
developed and partly covered by a smegma called the 
vernix caseosa ; the head has attained the proper hardness, 
and the scrotum usually contain the testicles. In female 
children the nymphae are generally covered entirely by 
the labia, the breasts project, and in both sexes contain 
frequently a milky fluid. 

As soon as the child that has been carried the full time 
is born it usually cries, opens its eyes, and makes some 
struggling motions with its limbs ; it soon passes urine 
and feces, and readily takes the breast. 

With occasional exceptions the position of the child is 
unaltered from an early period of pregnancy to its termi- 
nation, whether the head be upwards or downwards. The 
arms are generally folded over the chest, the knees drawn 
up to the abdomen ; the back curved, and the head bent 
upon the chest, so as to occupy as little space as possible. 
In ordinary cases the head is directed downwards, and 
the face looks obliquely, so that in the first and second 
position the back of the fcetus is turned partly forwards, 
and the belly in the third and fourth. We are enabled in 
many cases to ascertain the position of the fcetus in the 
uterus before labor has commenced, by means of the 
stethescope, by noting whether the pulsation is felt on one 
side or the other of the abdomen and observing whether 
it is heard clearly or not. 

The longitudinal diameter of the head is from 4 to 4J 
inches, the transverse from 3^- to 4, the vertical 3 to 3! 
inches. The transverse diameter of the shoulders and 
thorax is 4 J to 5 \ ; the widest diameter of the hips 4 to 5 
inches. In general the measurements are a little less in 
the female than in the male. 



108 Mother, Nurse and Infant. 

The head of the foetus is large, and as it is less com- 
pressible at term than other portions it merits a particular 
description ; we should be acquainted with all its charac- 
ters, that we may recognize them and thereby determine 
the position during labor. 

The fcetal head is ovoidal in form, the large extremity 
being posterior. Several bones enter into the formation 
of the cranium ; they are, ist, the frontal bone forming 
the forehead ; in the foetus even at term it is usually divi- 
ded ; 2d, the Uno parietal bones, one on each side of the 
head, meeting on the median line at the top of the head ; 
they help to form the vault of the cranium ; 3d, the occi- 
pital bone, forming the posterior and part of the base of 
the skull ; and 4th, the temporal bones, one on the right 
and one on the left side below the parietal, completing 
the lateral portions of the cranium and contributing to 
form the base of it. The cranial bones are not united to 
each other by sutures as they are in the adult, but are 
separated, the parietal bones especially, by membranous 
intervals, the intervals being larger in some children than 
in others. These intervals, or sutures and fontanelles, 
must be carefully studied. 

The sagittal suture is the antero-posterior one, and ex- 
tends from the root of the nose to the occipital bone. It 
is formed in front by the interval that separates the frontal 
bone into two halves, and superiorly by that between the 
two parietals. There is a suture which crosses this, called 
the transverse or coronal suture, which is formed by the 
space existing between the frontal and parietal bones. 
When the sagittal suture arrives at the superior angle of 
the occipital bone, it seems to part and give rise to two 
oblique lateral sutures which are called lambdoidal j these 



The Sutures and Fontanelles. 109 

are formed by the posterior borders of the parietal bones 
and the superior one of the occipital. 

Just at the point where the coronal and the lambdoidal 
sutures join the sagittal one, two membranous spaces, 
larger than those just described, are found ; these have 
received the name of fontanelles. 

In cases of head presentation during labor, one or the 
other of the fontanelles may be felt by the attending prac- 
titioner, and this indicates to him the position of the head 
and the presentation. 

The anterior fontanelle presents an extensive surface at 
the place where the transverse crosses the sagittal suture. 
It is lozenge-shaped, and is bounded by four bony angles. 

The posterior fontanelle is* formed by the union of the 
two lambdoidal sutures with the termination of the sagit- 
tal suture. It is smaller than the anterior one, and is of 
a triangular form. It is bounded by the occipital bone 
and the angles of the parietal bones. During labor the 
bones may overlap each other so that the sutures cannot 
be felt, but the prominences of the bony margins will aid 
the diagnosis. 

THE PHYSIOLOGY OF FCETAL LIFE. 

The ovule, after it arrives in the uterine cavity, comes 
in contact at all points with the mucous membrane of the 
uterus. Its nutrition at first is organic by superficial 
imbibition ; afterwards, probably the villi of the chorion 
imbibe the fluids there secreted, and transmit them into 
the space between the chorion and the amnion, thence it 
transcends through the walls of the amnion, and a portion 
is conveyed into the foetus through the umbilical vesicle. 
After the placenta is formed there may still be some ab- 
sorption of some of the nutritive matters contained in the 



no Mother, Nurse and Infant. 

liquor amnii through the skin of the foetus, but its growth 
is principally maintained by an assimilation of that which 
the radicles of the umbilical vessels take up in the pla- 
centa. By means of the extensive contact existing be- 
tween the vascular apparatus of the two placentas, a trans- 
udation probably takes place of some part of the maternal 
blood, which is absorbed and mingled with the foetal 
blood, and furnishes some of the nutritive material. 

When mingled with the foetal blood, the nutritive ele- 
ments supplied by the mother are devoted to the develop- 
ment of the organs. It is supposed, however, that they 
undergo changes in the large liver of the foetus and in its 
intestines. 

There is no true respiration in the uterine cavity, but 
one function of the placenta is to renew the blood of the 
foetus from that of the mother, in about the same way 
that the blood of fishes is aerated by the water passing 
through the gills. 

Whether in the earlier months absorption is carried on 
by the surface alone, or whether a portion of the liquor 
amnii finds its way to the stomach is difficult to decide, 
but, without doubt, a certain amount of digestion is car- 
ried on. 

The circulation of the blood in the foetus cannot be 
understood without referring to certain anatomical pecul- 
iarities that do not exist in the adult. These character- 
istics depend on the absence of respiration, and disappear 
when it is established. 

i st. The septum between the auricles of the heart is 
imperfect, having in its center a valvular oval aperture 
called the foramen ovale. 

2d. The pulmonary artery, soon after its origin, gives 
off a branch, the ductus arteriosis, which enters the aorta 



Fcetal Circulation. i i i 

just below the arch. The pulmonary arteries are very 
small. 

3d. The umbilical artery in the fcetus is a large vascular 
trunk, which is nearly obliterated in after life. The two 
umbilical arteries run forwards and inwards along the lat- 
eral and superior parts of the bladder, then curve forwards 
to the abdominal wall, along which they ascend to the 
umbilicus, then pass along the cord to the placenta. 

4th. The foetus further differs from the adult in having 
an umbilical vein, which comes from the placental tissue, 
traverses the length of the cord, passes through the um- 
bilical ring, is mostly distributed to the liver, but has a 
supplemental vein situated at the thick edge of the liver, 
and leading to the vena cava ascendens, called the ductus 
venosis. 

The general effect of all these peculiarities is to render 
the heart virtually a single one ; to provide for the quies- 
cent state of the lungs, and to modify the distribution of 
fresh blood. 

The course of the blood in the fcetus is as fol- 
lows : The blood circulating in the umbilical vein is, on 
entering the fcetus, a part of it discharged through the 
ductus venosis into the vena cava ; another part is distrib- 
uted to the liver, and is brought to the vena cava by the 
hepatic veins, and then mingles also with that from the 
inferior extremities, and then with that from the upper 
extremities as it passes into the right auricle. A part of 
this is transmitted through the right ventricle, and thence 
(except a supply for the nourishment of the lungs) through 
the ductus arteriosis into the descending aorta. A second 
and larger part passes through the foramen ovale into the 
left auricle, then into the left ventricle and arch of the 
aorta, the branches of which supply the head and upper 



ii2 Mother, Nurse and Infant. 

extremities. The continued stream passes into the de- 
scending aorta, mixing with that already described. The 
whole now descends to the lower part of the aorta, where 
a portion is sent to the inferior extremities, but a larger 
part is drawn into the umbilical arteries, and is carried by 
them into the placenta. 

After birth remarkable changes take place. Something 
in the circumstances in which the child is placed stimu- 
lates respiration and crying, by which means the lungs are 
inflated, and space is afforded to the pulmonary circula- 
tion, which supercedes the use of the foramen ovale 
and ductus arteriosis ; the blood from the lower extremi- 
ties cannot pass through the umbilical arteries, and does 
pass through the ascending cava into the right auricle and 
ventricle, then into the lungs, where it undergoes analo- 
gous changes to those effected in the placenta, and is dis- 
tributed to the body generally. The foetal openings are 
generally obliterated in the course of a week, though the 
foramen ovale, or the ductus venosis, may continue per- 
vious for two or three weeks ; but soon the ductus venosis 
and the umbilical arteries are obliterated and the adult 
circulation established. 



PAI^T III. 
Pregnancy and Parturition. 



CHAPTER I. 



diagnosis of pregnancy. 



A few of the early signs of pregnancy are not made 
available to the physician ordinarily when his opinion is 
demanded. A woman is naturally unwilling that her 
physician, if he be a man, should make even a digital ex- 
amination, and this makes it more necessary that the nurse 
should know all the rational signs. 

One of these signs is the changed color of the mucous 
membrane of the vagina and labia. This membrane is of 
a pale red color, but it becomes of a violet hue during the 
time of menstruation, and if a woman becomes pregnant, 
the violet or deep red color becomes continuous. 

There is also, even in the commencement of pregnancy, 
a peculiar odor to the secretion from the vagina and os 
uteri, which has been compared to that of the vernix 
caseosa. 

There is no sign of pregnancy by which we can always 
distinguish it in its early stages ; in some instances nearly 
all the rational signs are absent. The general condition 



,ii4 Mother, Nurse and Infant. 

of a pregnant woman is changed in a greater or less de- 
gree, but all are not changed alike. 

Generally she is plethoric, the pulse is fuller and quick- 
er ; the quantity of circulating fluid is augmented, the 
quality altered by the increase of fibrine ; but these 
changes are not always obvious. Well marked sympathies 
are excited in various organs ; the nervous system may 
suffer especially ; the woman's temper and disposition 
may change ; she may become capricious, may have likes 
and dislikes in eating, especially if her digestion is weak ; 
there may be loss of appetite, heartburn, increased flow of 
saliva, toothache, excitability of mind, sleepiness, etc. ; 
but even when many of these symptoms are present, even 
when the liver and kidneys are affected, so that the skin 
is sallow or discolored in patches, and irritability of the 
bladder causes much pain and distress, these various signs 
may only furnish a sum of probabilities amounting almost 
to certainty. 

In some cases of pregnancy the skin, instead of becom- 
ing sallow, is more florid, with occasional eruptions on the 
face. 

Some women become fat during pregnancy ; others 
lose flesh ; their faces, in the early months, are pinched 
and pointed, and their features altered. 

Milk in the breasts, especially in the first pregnancy, is 
a sign which is said to be reliable ; but it is true of some 
women that, during their period of menstruation, their 
breasts enlarge ; there is a sensation of fullness, with 
throbbing and tingling pain in them, and that a milk fluid 
may be secreted ; the same symptoms that are present 
with others at the second month of pregnancy. 

Another change is a more marked sign in the breasts. 
There is at first a soft and moist state of the skin, and the 



Signs oy Pregnancy. i 15 

little glandular follicles around the nipples arc bedewed 
with a secretion. This may often be seen at the second 
month, and it may also be noticed that the veins of the 
breast look more blue, and that the breasts themselves are 
firmer and more knotty to the touch. 

There are, however, other signs which are more to be 
depended on than these that have been mentioned. 

Females cease to be regular during pregnancy. A healthy 
married woman, during the period of child-bearing, bases 
her prediction upon this sign, and is seldom disappointed. 
But women are not all healthy; disease and disorder of the 
womb, or other organs of the body, especially of the lungs, 
may cause suppression of the catamenia ; and, on the 
other hand, the discharge may recur for several months 
after conception, or even monthly during the period of 
utero gestation ; and, in anamalous cases, some young 
married women, who had hitherto been quite regular, 
ceased to menstruate for several months without any 
known cause. 

Morning sickness is one of the earliest signs, of preg- 
nancy, as it often occurs within two weeks. The nausea 
may be slight or it may be very distressing ; it may hap- 
pen to be soon relieved, but it usually continues for three 
or four months or longer. It varies also as regards the 
time of day during which it continues to be bad ; but if 
it recurs at the regular time and in the regular manner, it 
is of great value as an evidence of pregnancy, when com- 
bined with other symptoms. 

A dark brown areola around the nipple may usually be 
noticed at the end of the second month ; this is a distin- 
guishing sign, especially if it be a first pregnancy. A 
month or two later, the dark color is more obvious, and it 
is darker in persons with dark hair, etc. It may be de- 



n6 Mother, Nurse and Infant. 

scribed as being a dark circle, somewhat swollen, or with 
a puffy turgescence, both of the nipple and the surround- 
ing disk ; the surface of the areola studded over and ren- 
dered unequal by the prominence of the glandular folli- 
cles, the integument covering the part soft and moist ; 
sometimes small mottled patches, of a whitish color, scat- 
tered over the outer surface of the areola, and for about 
an inch all around it. 

These marks are quite plain at the fifth month, and at 
six months a number of silvery streaks may be observed. 

Quickening is one of the most important signs of preg- 
nancy, and occurs about the fourth or fifth month ; not 
because the child is then first alive, but because the womb 
then rises higher in the abdomen, and because the child 
has reached a further state of development. Quickening 
is a proof that the woman is near half her time gone ; 
though it may happen that the sensation is observed as 
early as the third or fourth month, instead of at four and 
a half months. In some cases women do not know the 
time when they quicken, as only a slight sensation is felt ; 
this some compare to the fluttering of a bird. But a lady 
may at that time be faint, or giddy, or sick, though there 
seemed to be nothing more than a mere pulsation. Sub- 
sequently, however, the movements become stronger and 
more frequent. The motions of the child may be felt by 
a third person on placing the hand on the woman's abdo- 
men, especially if the person's hand be cold. I have 
known one case in which, by placing my hand on the wo- 
man's abdomen, I caused motions which similated active 
movements of the child, although there was no foetus 
present. 

Increased size and hardness of the abdomen is 
characteristic of pregnancy. Enlargement of the abdo- 



Signs of Pregnancy: 117 

men may be from flatulence, but such enlargement is not 
persistent ; the belly is large one hour and small the next, 
and on pressing the bowels firmly, a rumbling of wind may 
be heard, which perhaps may move about, and on percus- 
sing (tapping) the part, a hollow sound may be elicited, 
as from a drum. A large abdomen may be due to fat, 
but there is a soft and doughy feeling that is characteristic 
of fat. On the contrary, in pregnancy, hardness, solidity 
and resistance to pressure characterize the gravid uterus, 
and the enlargement is not only persistent, but gradually- 
increasing. It is true that when a very fat woman is preg- 
nant, percussion or palpation of the abdomen may be 
fruitless, and any certain diagnosis cannot be made, but 
in most cases, if we are careful to observe these condi- 
tions, and also whether there is a distended bladder and 
rectum, the diagnosis can be made after the fourth or fifth 
month. 

To make an examination by percussion and palpation, 
let the female lie down, with the head raised and the thighs 
flexed on the abdomen ; then examine with both hands, 
especially near the pubis. . Pressure with the ends of all 
the fingers, gradually moving them upward, will enable us 
to detect the womb, if it rise above the symphasis, and 
also the size and height of the fundus. 

Ballottement, or 1-epercussion, is used as a means of de- 
ciding upon the presence of a foetus ; a means that is most 
available about the fifth and sixth month. The female 
examined should be in an upright position, or if she be in 
bed, her shoulders should be raised. We are directed to 
introduce the forefinger into the vagina and touch the 
cervix uteri, or, rather, in front of the neck upon the walls 
of the uterus ; then slightly jerking upward by slightly 
flexing the first joint of the finger ; observe if something 



n8 Mother, Nurse and Infant. 

recede from it and fall again in a moment. The ballotte- 
ment is said to be a sensation " analagous to that produced 
by placing a ball of marble in a bladder full of water and 
then striking the bladder with the finger just under where 
the ball rests, when the latter is thrown up and falls from 
its own weight upon the finger that displaced it." 

When the vaginal touch is practiced, while one finger 
remains in the vagina, palpation of the uterus with the 
other hand may assist in the diagnosis by depressing the 
uterus, or by holding it firmly in place. Then the jerk 
of the finger upon the head of the foetus causes it to float 
upwards a little in the liquor amnii and descend. 

Auscultation is used to decide many cases of doubt- 
ful pregnancy. The pulsations of the foetal heart are 
generally perceptible by the fifth month. The examina- 
tion may be made by applying the naked ear to the abdo- 
men of the mother, she being placed on her back in the 
bed with her head raised. 

The fatal pulsations are frequent, generally from 120 to 
140 a minute. The uterine sou fie or bellows murmur may 
often be heard as early as the fourth month ; it is syn- 
chronous with the mother's pulse ; its seat is said to be the 
uterus, and some believe that it indicates the position of 
the placenta. This sound and the pulsation of the umbil- 
ical cord are not very important diagnostic signs, and the 
same may be said of the presence of kiestiene in the urine, 
which may, however, be detected as early as the third 
month. 

Some of the ailments that attend pregnancy I will now 
merely mention : There may be irritability and a disposi- 
tion to inflammation ; violent and obstinate vomiting ; in- 
digestion and depraved appetite, heartburn, costiveness, 
hemorrhoids, liver spots or blotches, especially about the 



Abortion. 119 

face ; diarrhoea or dysentery ; strangury, with a frequent 
inclination to void the urine ; leucorrhoea ; varicose veins 
in the legs, thigh and abdomen ; inquietude, and sleepless- 
ness ; dropsy, or an ©edematous condition of the lower 
extremities ; prurigo vulva ; either of these may be more 
or less troublesome, but can hardly be regarded as diag- 
nostic signs. Some remedies for these will be mentioned 
hereafter. (F. 69, 72, 75, 81, 131, 173, 206, 220). 

The abdominal walls are often distended beyond what 
the woman is able to bear without inconvenience, as the 
skin may become inflamed and crack. It is much more 
common that the true skin beneath the epidermis cracks, 
and, although the outside is not altered, there often re- 
mains upon the abdomen of women who have had children 
a number of small marks, or little whitish streaks. 



CHAPTER II. 



ABORTION. 



If a premature expulsion of the foetus occur before the 
end of the seventh month, it is called an abortion, or mis- 
carriage j subsequent to this period, premature labor. 

The cause of abortion may be in the ovum or in the 
mother, and it is more liable to occur at the beginning of 
each month corresponding to the menstrual period. The 
maternal causes may arise from the condition of the 
mother or may be accidental ; may be anything that in- 
juriously affects the mind or body. Debility of constitu- 
tion, consumption, leucorrhoea, uterine irritation, febrile 
complaints, and obstinate constipation may be causes, but 
some women who are weak or sick retain the ovum with 



120 Mother, Nurse and Infant. 

wonderful tenacity. Blows, falls, violent concussions, ex- 
cessive or sudden exertions, straining, severe coughing, 
taking long walks, riding on horseback, or over rough 
roads in a carriage, a long railway journey, fright, sudden 
shocks, anger, joy, sorrow, good or bad news suddenly 
told, taking a wrong step in ascending or descending 
stairs, lifting heavy weights, violent drastic purgatives, 
calomel, dancing, and tight lacing may excite the uterus 
to action and effect the expulsion of its contents. 

It is an unfortunate thing for a woman if she miscarry 
with her first and second child, for it often becomes a 
habit. Having once miscarried, she is more likely to mis- 
carry again, and by repeated miscarriages her constitution 
is broken, and the chances of her ever having a living child 
become very small. 

A woman may experience some threatening or warning 
symptoms of miscarriage for one or two days before those 
of labor supervene. There is usually a feeling of languor 
or weariness, of lassitude and depression of spirits, and a 
sense of uneasiness, and then, after these premonitory 
symptoms have lasted for some time, there may be a dis- 
charge of mucus or blood from the vagina. The show 
may increase to flooding, and soon there may be pain, at 
first slight and irregular, afterwards of a grinding charac- 
ter, and subsequently severe, irregular, and bearing down. 
At this stage we may be quite certain that the pains will 
continue to recur until the foetus at least, if not the after- 
birth, have passed into the vagina. 

The progress in different cases is, however, quite dis- 
similar. In the beginning of pregnancy the expulsion of 
the ovum might closely follow the accident that caused 
it. For example, a woman might slip in descending a 
staircase and fall violently on her seat, causing immediate 



Miscarriage. 121 

expulsion of the ovum, with a large quantity of fluid 

blood. There are some women who have acquired the 
habit of aborting, and the ovum passes out of the womb 
with scarcely any pain, little or no hemorrhage, and the 
woman speedily recovers. But it will very seldom hap- 
pen, after the first six weeks, that there is not some inter- 
val between the accident and the consequent abortion, 
and that there is not considerable and protracted pain. 

If the cause of the abortion affects the mother instead 
of the ovum, she generally experiences, at the time of the 
accident, a sharp pain about the loins or abdomen, which 
may continue slightly for several days, and then be re- 
newed, with violent uterine contractions, and some serous 
and then bloody discharges from the vagina. 

The progress of a miscarriage is not as regular as a labor 
at full term. In many cases there are shiverings succeed- 
ed by fever for a day or more preceding the hemorrhage. 
Severe indisposition may continue for several days. There 
may be not only considerable uterine pain, but much pain 
in the bladder and loins ; a sense of sinking in the epi- 
gastrium, of weight near the vulva and anus, and an inef- 
fectual desire to urinate. 

Such symptoms continue a longer or shorter time, and 
then usually the foetus alone is expelled, the placenta be- 
ing retained. The latter is generally detached after a 
time, or it may (if within the first three months) be dis- 
charged and pass out in a dissolved condition, with the 
lochia. Very alarming hemorrhage may precede and ac- 
company abortion ; this makes the case one of danger 
at the time, and may permanently affect the health of the 
woman afterwards. The flooding may continue after the 
expulsion of the ovum ; but I have always found that in 
such cases there was a portion of the placenta that was 



122 Mother, Nurse and Infant. 

detached, and that might be removed, though not perhaps 
without some difficulty. A good physician should always 
be called in cases of continued flooding. 

The patient ought always to preserve any and every 
substance discharged, that it may be showed to the physi- 
cian. He should make a digital examination, and he 
usually finds the os uteri to be partially dilated, and a 
portion of the placenta hanging in the orifice. It has 
always been my practice to see that all was removed be- 
fore leaving my patient, and I have known very danger- 
ous hemorrhage to occur where this rule was not observed. 
The placenta can generally be seized by two fingers and 
removed ; but if persevering efforts are necessary, they 
should not be relinquished until the safety of the mother 
is assured, which cannot be while the ovum, or membranes, 
or placenta remain in the uterus separated from their con- 
nections. 

But it should always be considered especially important 
to prevent the abortion. If a woman is prone to mis- 
carry, she ought, as soon as she is pregnant, to lie down 
a great part of the day ; she must keep her mind calm and 
unruffled, and must live on plain diet ; she should retire 
early to rest, and she must have a separate sleeping apart- 
ment. She should avoid taking active physic, but keep 
her bowels open by diet or by the mildest aperients, or, 
possibly, daily enemata. Gentle exercise may be taken, 
alternated with frequent rest. Cold ablutions are proper 
every morning, but the body should be rubbed afterwards 
with a coarse towel. 

The most usual time for a woman to miscarry is from 
the eighth to the thirteenth week, but if a woman have a 
particular time, which to her is the usual period, whenever 
that time approaches she should be unusually careful. 



Parturition. 123 

Let her lie down more than she usually does ; let her 
avoid exciting amusements. She might try to keep her 
bowels open by the external application of castor oil, or by 
the mildest aperients, or by hot water enemata. 

If slight hemorrhage and trifling pains come on, we 
should seek to arrest the abortion by giving perhaps grain 
doses of opium every four or five hours. If the hemor- 
rhage is severe, a drachm dose of fluid extract of ergot 
may be given, and a large draught of cinnamon tea ; per- 
haps a quarter of a grated nutmeg, and, in extreme cases, 
a spoonful of brandy with it. 

But let it be understood that in all such cases a physi- 
cian should be called as soon as possible ; and while wait- 
ing for him the patient ought to lie on a hair mattress ; 
a vaginal injection of hot water may be given ; she should 
have but scant clothing upon the bed ; her room should 
be well ventilated, and if she is faint from the loss of 
blood, a little aromatic ammonia may be given. 



CHAPTER III. 



PARTURITION. 



False pains occur most frequently in a first pregnancy, 
but most pregnant women have occasional pains, and 
these become more violent within three weeks of the full 
time. They may be owing to a disordered stomach, as 
well as to the action of the uterus ; but they usually come 
on at night, and are liable to be mistaken for labor pains. 
They are, however, unattended with show ; they often 
change from place to place, perhaps going successively 
to the hips, loins, lower extremities and abdomen ; they 



124 Mother, Nurse and Infant. 

come on at irregular intervals, and are at one time violent, 
at another feeble, and they occasion no dilation of the os 
uteri ; but true pains come on with some regularity, and 
usually increase in severity. False pains are from various 
causes, such as fatigue of any kind, especially too long 
standing, sudden and violent motions of the body, cos- 
tiveness or diarrhoea, general feverishness, agitation of the 
mind, or a spasmodic action of the abdominal muscles. 
It is necessary to adopt the means used for the relief of 
the pains to the apparent cause, and generally to give an 
opiate proportioned to the degree of pain, or to repeat in 
small quantities at proper intervals till the patient shall 
be composed. 

PERIOD OF GESTATION. 

The duration of pregnancy is not always absolutely a 
certain number of days. The usual term is ten lunar 
months, or nine calendar months and one week. If we 
could have correct records of all cases we should prob- 
ably find that half the cases of pregnancy terminated in 
labor in the fortieth week, but that in a few instances the 
term was prolonged to the forty-fifth week 3 and that in as 
many cases women were delivered of fully developed 
children as early as the thirty-seventh week. 

A woman may make her count pretty correctly as fol- 
lows : She should first note the last day of her being un- 
well. Let forty weeks from that day be marked in an 
almanac, and she may expect her labor to come on near 
that time. 

It may happen that a woman who never has her menses 
while she is suckling, may become pregnant and not have 
a date to count from ; but she ought in that case to reck- 
on from the time that she quickens. Although quicken- 



Parturition. 125 

ing takes place at various periods, she may then consider 
herself nearly half gone in her pregnancy, and calculate 
that in four and a half months she will be delivered. 

A woman may have a show for one or two monthly 
periods after her gestation commences, but the discharge 
may be distinguished from the regular menstrual fluid by 
its being either small in quantity, or by its clotting, and 
generally by its lasting but a few hours. The woman 
should reckon from the time when she had her last regu- 
lar menstruation. 

PARTURITION. 

Natural labor. The uterine functions are charac- 
terized by periodicity. If an abortion occurs that is not 
the result of an accident, it is generally at what would 
have been, but for conception, a monthly period, and even 
injuries are more likely to produce their bad effects at that 
particular time. So the normal period for parturition 
corresponds to a menstrual period, and generally labor 
may be looked for at about the tenth period after the last 
appearance of the catamenia. We can hardly tell why it 
so uniformly happens at that particular time ; the process 
is analagous to the falling of ripe fruit — it drops because 
the fruit is fully matured. 

It is not in accordance with the plan of this work to 
dwell at all upon any other than what is called natural 
labor, but I shall include in this class all such as are ter- 
minated by the natural powers, whether they be head, 
face, breach, or foot presentations. 

By presentation, I mean that part that presents itself 
at the brim of the pelvis, so that the accoucheur's finger 
impinges upon it as the end is passed into the center of 
the os uteri. 



126 Mother, Nurse and Infant. 

The diagnosis of the different presentations is made 
by the touch. The head may be known by the hardness 
and roundness, and more certainly by the fontanelles and 
sutures ; the breach by its general softness, and by the 
tuberosity of the haunch bone ; by the cleft between the 
buttocks, the scrotum or the vulva, and the anus ; the 
knee by the hardness and roundness of the bone ; the foot 
by its form, its being at right angles with the leg, the 
nearly equal length of the toes, the narrow heel, etc,; and 
the face by the inequalities of the presenting part. (These 
inequalities cannot at first be felt ; upon touching it we 
first perhaps detect the brow, then, as labor progresses, 
we may feel the nose, mouth, etc.) The head presents in 
about 98 cases out of 100. 

PHYSIOLOGICAL PHENOMENA OF LABOR. 

According to the division made by standard authors on 

parturition, its first stage extends from the beginning of 

labor to the complete dilatation of the os uteri ; the sec- 

. ond terminates by the birth of the child, and the third by 

the expulsion of the placenta. 

During the last two or three weeks of the term, the ute- 
rus sinks lower in the pelvis, and seems to spread out lat- 
erally ; the lungs and stomach are not so much com- 
pressed, and respiration and digestion, if difficult, become 
more easy, and often the patient becomes more cheerful 
and active. The precursory symptoms of labor vary in 
intensity in different women ; but it may be observed 
pretty generally that there is more activity and disposition 
to movement for one day preceding the real labor. 

But during the last few days of the gestation there are 
contractions of the uterus, which, though short and dis- 
tant, and not attended with much pain, are effective in 
dilating the cervix, and preparing for the subsequent labors. 



Commencement of Labor. 127 

The subsidence of the lower end of the uterus into the 
pelvis, however, causes many unpleasant symptoms. The 
pressure upon the bladder renders a frequent evacuation 
of its contents necessary ; there is often an ineffectual de- 
sire to urinate, and sometimes strangury. There is often 
a sense of weight about the anus, an irritable state of the 
bowels, occasional griping pains, and a desire to go to 
stool when but little is passed, and sometimes diarrhoea. 
The oedema and varices of the lower extremities augment, 
the hemorrhodal vessels swell up, and the piles are larger. 
These precursory symptoms are manifested more in pri- 
mapara than in others. To some, walking becomes at 
this time impossible. 

There are during the last month, and especially toward 
the close of it, painless uterine contractions ; there may 
be at first a sort of squeezing sensation with it. But 
about twenty-four hours previous to the commencement 
of actual labor, these contractions are accompanied with 
some pain and are periodical, recurring perhaps every 
twenty or thirty minutes. If an examination be made of 
the os tincae at the commencement of labor it will be 
found that the rounded collar of the os is already effaced. 
The pains then suddenly become acute, and it can be 
observed that the uterus contracts if we notice its greater 
hardness and roundness during a pain. The os uteri if 
somewhat dilated closes partially with each contracting, 
and it can be observed that its margins are growing thin- 
ner though tense and resistant at the time of the pain. 

The contractions distend the membranes ; these are 
first pressed on the neck, then into it, then as soon as the 
dilatation is sufficiently advanced engage in it in the form 
of the segment of a sphere, whose dimensions progressively 
increase with the dilatations. 



128 Mother, Nurse and Infant. 

There is now and perhaps has been for several hours a 
glairy discharge from the vagina, which becomes streaked 
with blood, there are perhaps shiverings or rigors (not 
accompanied with a cold skin), the pains increase in force 
and frequency, the pulse is hard, full, and rather frequent, 
the countenance is flushed, often there is vomiting, and 
the patient is prone to despond and be discouraged. 

She is less agitated after the pain subsides, though it 
does not cease entirely. During the interval the margins 
of the os again become supple, the membrane that was 
tense while the pain lasted becomes flaccid, and the child's 
head can be more plainly felt. As the contractions are 
repeated the os uteri dilates more and more until it is 
completely opened and no part of its margin can be 
touched ; though very frequently from some obliquity of 
the uterus, the margin on one side can be observed pushed 
down before the head of the child, while that on the other 
side cannot be reached. In ordinary cases the membranes 
are ruptured and the waters escape at the commencement 
of the second stage, and the time occupied by the* first 
stage is nearly three-fourths that for the whole labor. But 
the duration of the stages as well as the time occupied by 
the parturition is exceedingly variable, and the same may 
be said in regard to the duration and character of the 
pain. 

We may observe here that pain is nearly inseparable 
from the contractions of the uterus, so that in common 
language the two expressions are used indifferently ; but 
using the word in its ordinary sense the pain in the first 
stage of labor is different from that in the second. What 
are called grinding pains characterize the first part of la- 
bor, and although they differ in different individu als, they 
are pretty generally so severe as to cause the patient to 



Labor Pains. 129 

cry out. As soon as the labor advances to the second stage 
there is a change in the character of the pains. They are 
more frequent and longer and the intervals shorter ; but 
though the suffering may be greater the cry is more sup- 
pressed, the bearing down is carried to a greater degree, 
and each pain is succeeded by a calm more perfect than 
that in the first stage. Should the interval be rather long 
some patients get a little sleep between the pains, but if 
there has not been a bursting of the waters previously 
there is generally now a pain sufficiently hard to break 
the membrane. 

Either in the first or last part, or during the whole of 
the labor, the woman says that the pain is in her back, it 
being in the lumber and dorsal region ; the grinding pain 
she speaks of as being forward, they seem however to go 
through from the umbilicus to the sacrum. In cases 
where there is rigidity of the uterine orifice, there is I be- 
lieve pain especially in the back; and when the os becomes 
fully dilated, the pains are bearing down ; the patient at 
the accession of a pain holds her breath, and seizing hold 
of something with her hands, brings the muscles of the 
back and abdomen and extremities to aid the expulsive 
efforts of the uterus. I do not doubt that this straining 
of the mother at this time is advantageous ; these efforts 
of the mother should not be encouraged, however, at the 
first part of the labor, because then they do no good, nor 
at the very last, as combined efforts then may rupture the 
perineum. 

As the head advances through the pelvic cavity the 
pressure upon the nerves which pass through it gives rise 
to cramps in the thighs and legs. 

As the head passes into the vagina the walls become 
flabby and the canal seems to enlarge and elongate and to 



130 Mother, Nurse and Infant. 

be prepared to yield to the pressure of the head. If an 
internal examination be made the head will be perceived 
filling the cavity, descending with each pain and receding 
at its conclusion — the advance ordinarily exceeding the 
recession, though sometimes the gain is not perceptible. 
When the head rests on the perineum, that offers some 
resistance, which seems to stimulate the uterus and ab- 
dominal muscles to greater efforts and more forcible 
contractions. 

If it be a first labor there may be at this point a little 
delay in its progress. But the foetal head being forced 
down by the rapidly recurring pains so presses against the 
floor of the pelvis that it yields and becomes bulging in 
front, and distended, though there still is recession as the 
pain intermits. But adequate force is called into action ; 
each pain gains upon the advance made by its predeces- 
sor ; the vulva partially opens, and at each pain they open 
more and more ; the resistance of the parts is finally over- 
come. After the perineum has given the head its proper 
direction in its transit, there usually comes a hard pain — 
forcing a loud cry from the woman — another pain suc- 
ceeds immediately, which expels the head altogether from 
the parts ; then after a short rest the uterine power is 
again exerted to expel the body of the child. 

There may be an interval of a few minutes before the 
pains return with sufficient force to expel the shoulders, 
but the child is in no particular danger ; it is best to wait 
awhile, the nurse in the meantime making pressure with 
her hand over the uterus, before any traction is made on 
the head or shoulders. If the body is very large, however, . 
it may be well soon to draw a little on the head or to 
reach with one finger into the axilla and to bring down 



Delivery. 131 

the lower shoulders ; then the rest will be delivered with- 
out any difficulty. 

The intense suffering of the mother is now exchanged 
for perfect joy or ease ; there is at once a transition from 
extreme misery to total freedom from pain, though the 
labor is not yet completed. Ordinarily a few pains return 
before many minutes, and complete the last stage of labor 
— the expulsion of the placenta. Sometimes the contrac- 
tions that expel the child, expel also the membranes and 
placenta ; but more generally they are only partially de- 
tached or they may be adherent and not easily removed. 

After the birth of the child, and the tying of the naval 
string, it is proper to apply the hand upon the abdomen 
of the mother to ascertain whether there be another child, 
and whether the uterus be contracting properly. I advise 
that an effort should be made immediately to remove the 
afterbirth and secundines, making firm pressure over the 
womb ; this will generally stimulate the uterus to make 
good contractions, and may assist in pressing out the pla- 
centa. I do not advise that a midwife should pull upon 
the cord, but it is my practice to press the fingers of my 
right hand well into the vagina, and as soon as possible 
grasp a little of the placenta ; my left hand at the same 
time pulling slightly on the cord, and thus by combined 
effort removing the afterbirth pretty quickly. 

I have never had much trouble about retained or ad- 
herent placenta in cases where I myself officiated in the 
delivery, and I attribute my good fortune in this respect 
to the fact that I do not tie the placental portion of the 
cord, preferring to let some blood discharge from the 
afterbirth, thus diminishing its size, and then if necessary 
I direct that considerable effort be made in the way of 
squeezing and pressure and friction over the uterus. 



132 Mother, Nurse and Infant. 

It is true that if nothing is done a pain will usually 
come on within twenty minutes that will expel the after- 
birth very effectually including all the membranes, and 
considerable clots of blood ; but I apprehend that in 
many cases during this delay there is an hourglass con- 
traction of the womb comes on, which retains the placenta 
and prevents its proper separation. 

But before attending to the placenta, the necessary at- 
tention should be paid to the child. A little cold water 
sprinkled on it will usually make the child cry, if it does 
not breath immediately after it is born, and this makes the 
change in it from uterine to breathing life. The child 
may then be separated from the mother by cutting the 
cord. After the removal of the child it is proper to en- 
deavor to deliver the afterbirth, though it may not be 
necessary at first to do anything more than to use friction 
over the uterus with moderate pressure, which may be 
gradually increased. 



CHAPTER IV. 

MECHANICAL PHENOMENA OF LABOR. 

The cavity of the uterus and that of the pelvis form a 
continuous passage through which the child must be 
forced in its exit from the womb at birth. The uterus 
possesses the character of muscularity and is the main 
agent in the expulsion of the child. By its own muscular 
action the cavity of the uterus is diminished and pressure 
made on the foetus, forcing it down towards the orifice, 
distending the cervix, and dilating the passage. During 
the second stage of labor the power of the uterus is aided 



Mechanical Phenomena of Labor. 133 

by the voluntary muscles of the abdomen and by the de- 
pression of the diaphragm. 

The character of the passage will be brought to mind 
by recalling what was heretofore said of the diameter of 
the pelvis. It will be remembered that the usual antero- 
posterior diameter of the brim does not exceed 4^ inches 
while the transverse is 5^ inches, and that at the lower 
outlet the antero-posterior diameter is about 5 inches and 
the transverse about 4 inches. 

The first obstacle which the child meets in its pro- 
gress is the cervex uteri. This being composed partly of 
muscular fibre which acts somewhat as a sphincter, and 
partly of elastic celular tissue, holds the sphincter in the 
tissue with a tenacity which is not easily overcome. But 
repeated muscular contractions of the womb force down 
the bag of waters, which forms a sort of wedge, and this 
is forced down and into the os uteri, compelling it to open. 

There are also muscular fibres in the uterus which have 
a longitudinal as well as some that have a circular course, 
and the action of the former tend after a time to retract 
the os, over the foetal head. 

The second obstacle is the bony brim of the pelvis into 
which the head of the foetus cannot pass until its long 
diameter is adapted to certain diameters of the pelvis. 
The diameter of the bony pelvis is diminished over one- 
fourth of an inch by the soft parts upon it, but the oblique 
diameter of the pelvis will admit the long diameter of the 
head of the child, which does not often exceed 4^ inches. 
The head usually presents in this way, and passes in a 
somewhat spiral manner until it arrives at the outlet where 
the diameters are adjusted to each other. The head is, 
however, too large to pass, even in this way, were it not 
that it admits of a degree of compression to facilitate the 



134 Mother, Nurse and Infant. 

entrance and progress through ; this moulding is effected 
by the continued pains. The head of the child which 
presents at the brim with the occiput towards the left 
acetabulum rotates during the passage, so that the occiput 
at its exit is directly under the symphasis pubis ; the 
cause of the rotation is found in the form and direction 
of the passage and in the shape and size of the f cetal head. 
This presentation and position is the most common one, 
though either of the following is liable to occur. By 
naming the position we indicate just how a presenting part 
lies, or is turned. We adopt the following classification, 
which accords with several good authors : 

PRESENTATIONS AND POSITIONS. 

Presentations. No. Position. Name of Position. 

f i Occiput to left acetabulum. Left occipito-iliac anterior. 

| 2 " " right " Right " " 

/V—Yerfevorhead J 3 " " Symphasis pubis. Occipito pubic. 

a \ ertex or neaa < « " r. sacro-iliac junc. R. occipito-iliac posterior. 

5 " « 1. " ^ » " L. _ ;• 

[_6 " " promon'y of sacrum Occipito sacral. 

f i Sacrum to left acetabulum. Left sacro-iliac anterior. 

B-Breach,includ- 1 2 » \\ right , ." .. ? ight " v " 

W inferior « ■! 3 symphasis pubis. . Sacro pubic._ 

ins uucimi "-I ii n r . sacro-iliac junction. Left sacro-iliac posterior, 

tremities. | * « ,. { it it „ Right « t . 

[6 " " promont'y of sacrum. Sacro sacral. 

C — Body, including shoulders, elbow and hand. 

D — Face, including six varieties. 

The right occipito-iliac posterior (A 4) position is not 
a very uncommon one, but that variety which is described 
and named as the left occipito-iliac anterior (A 1), in 
which the occiput is directed in front and to the left, is 
most frequent. These and other vertex presentations 
may be recognized even in the commencement of labor 
through the vaginal walls, the head being known by its 
rounded spheroidal surface. 

Supposing that we have a case of the kind that is most 
common (A 1), and that labor has begun, we may intro- 



Presentations and Positions. 135 

duce the finger through the os uteri and we encounter a 
rounded, smooth and resistant surface, which is the ante- 
rior part of the head, and then by directing the finger 
upwards and backwards it will come in contact with the 
sagittal suture. 

If the direction of the suture is oblique, and if it runs 
from before backwards and from the left towards the right, 
the position must be either the left anterior or the right 
posterior occipito-iliac one. (A 1 or A 4). 

To complete the diagnosis we follow with the finger the 
sugittal suture until it reaches the fontanelle, and this 
determines the position. If the posterior fontanelle is 
found to the left and in front, and the anterior one is to 
the right and behind, the position is A 1, or the left antero- 
occipito-iliac one. The back of the foetus is turned for- 
wards and towards the left side, while its face and anterior 
plane is turned backwards and towards the right, and the 
occipito-frontal diameter of the child's head corresponds 
to the oblique diameter of the pelvic brim. 

As the labor progresses and the head is forced down in 
the pelvis, it is also more strongly flexed on the chest and 
the occiput is pressed down in the excavation. With the 
occiput thus presenting, it traverses all the space between 
the superior and inferior straits until it reaches the floor 
of the pelvis ; there it makes what is sometimes called the 
pivot turn — it executes a movement of rotation, which 
carries the occiput behind the symphasis pubis and the 
forehead towards the hollow of the sacrum; then the head 
being pressed forwards and stretching the perineum, the 
forehead and face being disengaged from it, emerge; then 
after the perfect expulsion of the head it again rotates, the 
occiput turns somewhat to the left thigh and the face to- 
wards the right thigh. 



136 Mother, Nurse and Infant. 

In the beginning of labor the shoulders are turned so 
as to correspond to the oblique diameter of the pelvic 
cavity, but they pass through the pelvis in a transverse 
position. After they reach the inferior strait, the body 
rotates so that the right shoulder of the child turns to- 
wards the left side of the mother and the wide diameter 
of the shoulders is accommodated to the wide diameter of 
the strait, and the rotation of the head, which is free ex- 
ternally, is secondary to the rotation of the shoulders. 

In the expulsion of the body the right shoulder, or 
sub-pubic one, is the first one to appear in the vulvar fis- 
sure, but the left or posterior one may be disengaged at 
the commissure of the perineum before the right one is 
delivered ; the remainder of the trunk is expelled very 
soon, describing a prolonged spiral course in its passage. 

A child originally in the right posterior-iliac posi- 
tion becomes converted towards the last of the labor into 
an occipito pubic or anterior one, and the labor terminates 
as it does in A 1, when the occiput was originally in front. 
It is the left shoulder, however, which gets behind the 
arch of the pubis, and the occiput is directed towards the 
right thigh after the head emerges. 

In some instances, though rarely, the child originally in 
A 4 position remains with the occiput behind to the ter- 
mination of the labor. In such cases the forehead comes 
under the pubis and remains there for a time, while the 
occiput traverses the whole circle of the perineum ; then 
the whole head and face is immediately delivered. 

It is not deemed necessary to describe here the mechan- 
ism of labor in the more unusual varieties which are so 
very numerous. 

As regards prognosis, head presentations are the most 
favorable of all, and those in which the occiput looks an-. 



Natural Labor. 137 

teriorly in the beginning of labor are more favorable than 
those in which it is turned posteriorly. In occipito-pos- 
terior positions the labor is more tedious than when the 
occiput is in front, and the expulsion becomes particularly 
difficult when the head maintains its original position and 
does not rotate or take the pivot turn. 

Upon the fcetal head after it is delivered there is almost 
always a protuberance to be found — a tumefaction, more 
or less considerable upon some point of the vertex ; its 
greater size indicating a longer continuance of the labor, 
and its seat indicating in what position the child was born. 
This tumor is almost always located on one of the poste- 
rior superior angles of the parietal bones, and shows that 
the occiput escaped under the pubic arch. During the 
labor the whole head is strongly compressed except at one 
point on the vertex, which therefore becomes the seat of 
a sero-sanguinolent infiltration. This tumor disappears 
usually within forty-eight hours ; if it does not, it may 
properly be punctured. It may contain either serum, or 
serum and blood, or grumous blood. 



CHAPTER V. 



DIAGNOSIS OF ARTIFICIAL LABOR. 

When the expulsion of the foetus takes place from the 
efforts of nature alone, the labor is called by some authors 
spontaneous or natural, but when art is obliged to inter- 
fere it is called artificial. It would be very useful to us 
if we could always decide in the commencement of labor 
whether the assistance q( art would be required, and I 
will group together in a few pages such instructions as I 
am able to give on this important subject. 

The nurse or midwife will not very generally be able to 
decide any point by auscultation, but she as well as the 
physician may judge from the appearance of the woman, 
from her past history, from palpation of the abdomen, and 
from vaginal touch. She should accustom herself to 
judging by all these means, that she may be able to decide 
early whether the help of an accoucheur will be impera- 
tively needed. 

No one can decide certainly from simply seeing a pa- 
tient in the beginning of labor, whether her labor will be 
natural and spontaneous, or artificial ; but I have many 
times when first looking at a lady, if her complexion was 
fair, and her form good, but rather tall, predicted that her 
accouchment would proceed regularly and favorably. 
But in forming our opinion we need to know something 
of the previous health and present ailments of the patient, 
and, if a multipara, the character of former labors. If 
nausea and vomiting or any other ailment has reduced 

i 3 8 



Diagnosis of Artificial Labor. 139 

her strength so that she is exceedingly weak, this may give 
rise to some reasonable apprehension ; but I have known 
a woman that could scarcely retain a morsel of food on 
her stomach for seven or eight months, that had become 
very weak indeed and exceedingly emaciated, who yet 
endured her labor well and soon- recovered. The general 
rule is, that the more perfect the woman's health is, the 
better she is fitted for child bearing, but if her general 
health and strength is reduced below its proper standard 
by some previous or accompanying disease, such for ex- 
ample as consumption, she may endure the labor very well, 
and succumb to the disease afterwards. 

Pregnant women are liable to be attacked with epidemic, 
endemic, and sporadic diseases. Eruptive fevers, etc., 
may attack purturient women, and if they do, the disease 
and labor in every case will have a reciprocal influence on 
each other — the disease will complicate the case. Influ- 
enza or intermittent fever may attack a woman at any 
period of gestation, and there may be no serious results. 
Cholera, small pox, typhoid fever, scarlet fever, measles, 
pneumonia, and jaundice are liable to cause abortion, and 
there is danger of fatal results, or either of them would be 
a dangerous complication at the time of labor. Syphilis 
would be a cause of abortion or premature labor, and any 
disease which allows the mother to carry the child the full 
term may reduce and weaken her. Glandular engorge- 
ments and scrofulous ulcers improve during gestation, but 
if the woman is suffering from a fracture, the bones will 
not unite very well. Tumors in the abdomen and pelvis 
may be an obstacle to delivery, and ulcerations of the 
cervix may also be harmful and protract the labor, as also 
may constipation, dropsy, and abuminaria. 

The latter may not be detected without an analysis of 



i4-o Mother, Nurse and Infant. 

the urine, but dropsy will be obvious as soon as it exists. 
The evidences of tumors and ulcerations are found by 
palpation and the touch — sometimes by the use of the 
speculum. 

After learning the present appearance and the former 
history of the patient it may be necessary to examine fur- 
ther perhaps by palpation. 

By palpation we may sometimes (but not always) dis- 
tinguish the head of the child, and perhaps tell to which 
side its back is turned. When making the examination 
let the patient lie on her back, make gentle pressure when 
the pains are off and the abdomen is relaxed ; press the 
ends of your fingers above the body of the pubis ; by 
pressing downwards you may perhaps feel the head if it 
has descended into the pelvis. You will need to press 
the abdomen carefully all over to ascertain if there are 
tumors, and also to ascertain if the body or some other 
part presents at the cervix uteri. 

If auscultation is used we may determine positively the 
position of the foetus by observing just where the sounds 
of the foetal heart may be most plainly heard. 

The vaginal touch is the usual mode of determining 
whether there is an unfavorable presentation of the child, 
as well as whether there is deformity of the pelvis, tumors 
in the vagina, ulcerations, &c. 

When the head presents in the commencement of labor, 
if the fundus of the uterus is not too much inclined for- 
wards, and there is no deformity of the pelvis, the os may 
easily be reached, and the hard round head of the child 
be felt without difficulty. Should a hard presenting part 
not be felt either through the dilated os or the walls of 
the uterus, it may be because there is a breech or body 
presentation, or there may be twins, or there may be an 



Presentations. 141 

unusual amount of water in the uterus, or the child may 
have hydrocephalus — in either of these cases it might not 
be possible to decide immediately about the presentation 
and position. 

Face presentations cannot be detected very early in 
the labor. Before the membranes are ruptured the head 
is high and difficult of access. When it is reached the 
forehead is first encountered, afterwards we may feel the 
nose and mouth. It is unfortunate for us that we cannot 
usually distinguish a face presentation in the early stage 
of labor. It is not so important that we make an early 
diagnosis of presentation of the breech, as there is no 
danger to the mother involved in the latter. 

Presentation of the body should always be detected 
early, at least as soon as the membranes are ruptured. 
The abdomen of the mother is much longer in the trans- 
verse diameter than is usual, and the head of the child 
may sometimes be felt in the iliac fossa. The form of the 
mother's abdomen is irregular as the foetus lies curved on 
itself. When we are able to touch the foetus, if the 
shoulder presents, we first feel a small bony projection, 
the acromion point of the shoulder ; then other points, 
including the acute angle of the shoulder blade. We 
should ascertain as soon as possible on which side the 
head lies, and also the posterior plane of the child. 

Sometimes the hand comes down in the vagina or even 
appears at the vulva ; if it does we may know by that 
(and by slipping the finger of our hand up into the axil- 
lary space) just how the child lies. If the back of the 
child's hand is turned towards the mother's right thigh 
the head is to the right, and if to the left thigh, to the 
left. The little finger being towards the coccyx indicates 
that the child's back is towards the mother's loins, and 



142 Mother, Nurse and Infant. 

the same finger being towards the pubis is evidence that 
this is in front. It is quite important that these points 
should be noted. 

There are various causes of tedious, difficult and ob- 
structed labor, and in each case we are obliged to depend 
principally upon the touch for diagnosis. In some in- 
stances the difficulty will be obvious as soon as we attempt 
to make an examination. A narrow and undilatable 
vagina will be easily recognized, but this will rarely be 
found a serious obstacle to the passage of the child ; as 
the labor proceeds the vagina seems naturally to dilate 
and to be more softened and relaxed. 

Cases have been reported where there was a scirrhus 
tumor or cancer connected with the neck of the uterus, 
even during labor ; happily such cases are rare. The 
scirrhus would be felt hard and unyielding. A tumor of 
any kind connected with the os uteri, the vagina or the 
rectum may obstruct the descent of the child's head more 
or less according to its size and mobility. Of course they 
can be detected. 

A vaginal cvstocle ought always to be rectified. It 
sometimes happens that the bladder is caught by the head 
of the child in its descent into the cavity of the pelvis 
and pushed before it, and it can be seen as a soft red 
tumor between the vulva. The finger can be passed pos- 
terior to it, but not anterior, and the catheter cannot be 
passed in the usual direction. 

A few cases are on record where a stone (calculus) in 
the bladder was pushed down before the fcetal head. A 
careful examination will show that the tumor is covered 
by the bladder ; its hardness will indicate its nature. 

A COLLECTION OF HARDENED FECES IN THE RECTUM is 



Causes of Slow Labor. 143 

detected without difficulty. It will be of an irregular 
form, hard and inelastic. 

Swelling of the soft parts may cause obstruction. 
If the child's head is detained for a long time pressing 
upon the brim of the pelvis, it may obstruct the circula- 
tion and diminish the capacity of the passage. In such 
cases there is unusual heat and dryness in the parts. 

When a nurse or midwife makes an examination by 
touching, she needs to continue it through several pains, 
and to repeat it again soon to know if there is any progress 
to the labor. If the progress is very slow this may be 
from various causes, some of which I will now simply 
name. It may be because the uterus is very much dis- 
tended, and this renders the pains inefficient ; there may 
be partial and irregular contractions of the uterus, weak- 
ness of constitution, fever or local inflammation, a want 
of irritability in the constitution, a deformity of the pelvis 
and spine, or doubts and fears on the part of the patient 
may diminish the action of the uterus. The labor may 
be slow because it is the first one, or because the mem- 
branes were ruptured too early, or because the woman is 
advanced in years at the time of having her first confine- 
ment. The uterus may be pitched over obliquely, there 
may be extreme rigidity .of the os uteri, extreme rigidity 
of the soft parts of the mother, a contracted or small pel- 
vis, the head of the child may be large and ossified so as 
to be unyielding. One or both arms may come down by 
the side of the head of the child ; on the part of the 
mother there may be a distended bladder from inability 
to void the urine, there may be cicatrices (scars) or adhe- 
sions of the vagina, and in some cases it has happened 
that an enlarged ovary has dropped down into the pelvis, 
or a portion of intestine containing scybula or hardened 



144 Mother, Nurse and Infant. 

feces obstructs the passage, or the os uteri is very minute, 
or imperforate, or totally absent. 

Some of these cases may demand the interference of 
art in. the first stage of labor, but delay at that time in- 
volves very little danger ; as a rule neither the mother nor 
child is in danger (except when there is hemorrhage or 
convulsions) on account of labor before the membranes 
are broken. If the nurse can ascertain the cause of the 
delay and finds that time is what is especially needed, she 
must exercise patience herself and encourage her patient 
to do so. 

It is hardly possible to predict beforehand in what cases 
convulsions will occur, but if there is much headache in 
the commencement of labor and if there has been consid- 
erable albumen in the urine of the patient, we have espe- 
cial reason to apprehend trouble of that kind. 

The history of the case is important in forming an 
opinion as to whether there may be severe hemorrhage. 
Some women are naturally predisposed to flowing. 



PAI^T IV. 
SKILLED NURSING AND MIDWIFERY. 



CHAPTER I. 

PRELIMINARY INSTRUCTION TO THE NURSE MIDWIFE. 

It is my design in giving the following instructions to 
prepare the student of this work to be a skilled or skillful 
nurse, not to be simply a midwife ; to act in conjunction 
with, not in opposition to, physicians; to conform to, and 
not to violate laws which regulate the practice of medi- 
cine; to officiate in cases of easy, natural labor some- 
times, but never in cases requiring the use of instruments; 
to be prepared to act in emergencies until the doctor can 
come and take the case; not to treat the case when the 
services of a physician can be obtained and is desired or 
needed; in short to act intelligently in all cases in which 
women now act perhaps blindly, hurriedly and ignorantly. 

The present state of feeling among our people, and 
especially among the medical profession in this country, 
would not sanction an effort to educate women solely as 
midwives. 

But there is a general feeling or sentiment that every 
young lady ought to have that kind of education which 
may render her useful; that she should be prepared in 
some way to minister to the desires, wants and needs of 



146 Mother, Nurse and Infant. 

her fellow creatures, and that some part of that knowledge 
or skill should be of that kind which would be available 
if these persons were thrown on their own resources; 
hence I would have some of you to be, not only nurses of 
the sick, but skilled nurses of lying-in women. And 
should some young lady after studying this work, decide 
to pursue the study of medicine thoroughly and become 
a physician, the knowledge here obtained would be avail- 
able. 

PRELIMINARY INSTRUCTIONS. 

i. Do not stop short of a thorough knowledge of this 
book, every part of it. 

2. Endeavor here to get a knowledge of midwifery 
that will qualify you to attend ordinary cases of natural 
labor, and enable you sometimes to give medicine when 
needed, and when there are no physicians in attendance; 
but understand that there are many times when the only 
proper thing for you to do is to send for a physician or 
experienced accoucheur. 

3. Do not hesitate to seek knowledge and experience 
and instruction from any source where you think that you 
can obtain it. Physicians will be willing to aid you, and 
I think the time is coming when he will regard the edu- 
cated nurse as his friend, and not as his natural enemy. 

4. I do not think it best that you should call yourself 
a midwife, because if you do it will excite misapprehen- 
sion and prejudice. Seek in every way to be skillful as a 
nurse, and seek to have a corresponding reputation. 

5. Do not undervalue your position, if you have the 
wisdom and courage and perseverence necessary to pre- 
pare you to minister to your sex in their time of greatest 
suffering and trial. Do not doubt that your mission is an 



Instructions to Nurse Midwii e. 147 

honorable one. And even if you do not minister very 
often to the sick in labor, except as the right arm of the 
medical man, you may help to raise the standard quali- 
fications of the nurses of our land. Do not suppose that 
I am complaining harshly of our present supply of nurses. 
Women have shown a wonderful adaptability to the needs 
and exigencies of their suffering friends in nursing and 
caring for them. And it is because they are so ready to 
receive instruction that I endeavor here to furnish good 
instruction for them. 

6. Do not suppose that your knowledge obtained by 
study is sufficient to enable you to act as midwife (except 
in an emergency), unless your studies are supplemented 
by observation, as mother nurse, &c. 

7. Do not be unwilling to minister to women who are 
poor. The young physician is willing to do something in 
this way to gain experience and for the sake of humanity, 
and this will be your opportunity to gain experience with- 
out coming in competition with rivals. 

8. The nurse as well as the medical man, must study 
the phenomena of labor at the bedside of the patient. 
No one can be qualified by mere reading for the duties of 
a midwife, and no woman that is diligent and observing 
can attend a case of labor without some addition to her 
knowledge. 

INSTRUCTION TO THE NURSE MIDWIFE. 

When I use the term nurse midwife I mean a nurse 
that has some knowledge of midwifery, that can be called 
to attend to women near the time that she expects to be 
confined, and that can remain in attendance for two 
weeks or more if it is desired or necessary. Sometimes a 
woman would, if possible, have a skilled nurse with her a 



148 Mother, Nurse and Infant. 

week or more before confinement, especially because she 
would thereby avoid sending for the physician unneces- 
sarily, and because she would be less likely to detain him 
for a long period of time. 

If the nurse midwife understands her business she will 
in some cases do better for the woman than a physician 
in the commencment of labor. For instance, suppose 
that a doctor is called a distance of five miles and away 
from his home and his other patients, and when he ex- 
amines the case the pains seem to be of the character of 
false labor pains. He knows that the real good of the 
patient might require that she should take an opiate, but 
the doctor would be unwilling to give it lest it might pro- 
tract a real labor, and subject all parties to the incon- 
veniences of a prolonged labor including unnecessary 
visits of the doctor. The nurse who can remain with the 
patient, if the labor should not be concluded in several 
days, would be more likely to do just what the good of 
the woman requires. And in such a case a skilled nurse 
would be" peculiarly acceptable to a physician if he 
chanced to be called, because he would be much more at 
liberty to leave his patient if it seemed necessary to do so. 

When a nurse midwife is called to attend a case, she 
should carry with her besides disinfectants, a male 
catheter, some laudanum or other opiate, quinine, and 
extract ergot, in order to be prepared for emergencies. 
Ordinary cases may require no medicine, but some 
cases do. 



CHAPTER II. 



THE NATURAL LABOR. 



A natural labor has been described as one " in which 
the head presents, and descends regularly into the pelvis ; 
where the progress is uncomplicated, and concluded by 
the natural powers within twenty-four hours, (each stage 
being of due proportion), with safety to the mother and 
child, and in which the placenta is expelled in due time." 

A skillful, careful examination in the commencement 
of labor will enable you perhaps to decide whether the 
labor will be natural or otherwise. But it may be your 
duty first to know if your patient is in ordinary health, or 
if she have any fever or organic disease, and you should 
enquire about the bodily functions generally, the condi- 
tion of the pulse, skin, &c. Before making a digital ex- 
amination you should notice the character of the pains, 
their frequency, force and regularity, the amount of vol- 
untary effort, the character of the outcry, &c. From 
these enquiries you probably will be able to decide 
whether she is suffering from real labor, or false pains. 

She will, however, probably not object to a digital ex- 
amination and your opinion will be founded principally 
upon that. The modern practice is to wash the hands in 
antiseptic soap or some solution before making an exam- 
ination. 

We are directed by most writers to have the patient lie 
upon her left side near the edge of the bed when we ex- 
amine her. The fore finger of the right hand (sometimes 



iSo Mother, Nurse and Infant. 

the left) after being well oiled or soaped should be passed 
along the perineum into the vaginal orifice, and is to be 
pressed upward and backward towards the promontory of 
the sacrum until the os uteri or the presenting part is 
found. Sometimes this is not reached without an effort. 
When reached endeavor to find the fcetal head or to de- 
termine what is the presenting part — feel sufficiently to 
distinguish the lips of the os uteri from the presenting 
portion of the foetus. Do not be hasty in making the 
examination ; wait till you examine sufficiently to know 
if the child is forced down ; observe both during the time 
of a pain and during an interval, and observe if the pains 
dilate the os. Sometimes during a natural labor there 
may be a severe pain, and when the pain is hardest, the 
os contracts. By waiting to take a number of pains you 
will learn if there is real progress. When examining, 
note the calibre, heat and moisture of the vagina; the 
general condition of the cervix; the dilatability of the os 
uteri and the actual dilatation by the bag of waters or 
the fcetal head during a pain. If the head presents you 
can best learn the particular position when the pain is 
off; and after the membranes are ruptured you can decide 
better than previously. Ordinarily the sagittal suture 
can be felt, and perhaps both fontanelles, but you must 
not be discouraged at all if you cannot determine the 
exact position. Doctors ordinarily do not deem it neces- 
sary. 

If you can decide that it is a head presentation and 
that the woman is undoubtedly in labor, you may proba- 
bly decide that the labor will be natural, and you may 
properly tell the friends so, adding perhaps, that it will 
depend upon the character of the ensuing pains whether 
the labor will be protracted or short. 



Causes of Tedious Labor. 151 

Various circumstances of which you are possibly not 

yet cognizant may make your case of labor a tedious or 
difficult one. You have decided, perhaps, that there is 
no obstruction to the passage of the child, no deformity 
of the pelvis, scirrhus or other tumors in the vagina, no 
cystocele, no prolapsed ovary, and that there is not a 
rigid perineum or imperforate vagina. If there is, you 
need to have a medical man present, but should none be 
obtained you will need to repeat your examination from 
time to time. Observe if each pain presses down the bag 
of waters and dilates the mouth of the womb, and if the 
soft parts are in a relaxed state, and if there is a show. 
Even if the appearances are thus promising, the labor may 
be slow and tedious from various causes. 

1. Possibly hardened feces maybe in the rectum ; if 
they are you may be assured of the fact when you make a 
digital examination, as they seem like tumors posterior 
to the vagina. The remedies are physic, enemas, rest — 
possibly opium. 

2. Inefficient pains may be due to a bladder distended 
with urine. When this is. suspected we should observe 
whether there is abdominal swelling (not tympanitic) low 
down ; pain on pressure which gives rise to a desire to 
urinate ; a constant desire to pass water though the pa- 
tient has just performed the act, or a dribbling of water 
from the parts. If the bladder cannot otherwise be re- 
lieved a catheter should be used, and as a precaution to 
avoid wetting the bedclothes it is well to have a catheter 
made long enough by affixing a piece of India rubber 
tubing to the end of it to reach a vessel at the side of the 
bed. Never use force in passing a catheter in. It is very 
seldom that it is necessary to use it at all during labor. 

3. If there is a hernial protrusion of the bowel, or a 



152 Mother, Nurse and Infant. 

calculus of the bladder falling down in the passage you 
will probably have a medical man to officiate. But I may 
say that if there is need of your doing anything to replace 
them, or if it is necessary to return a prolapsed bladder, 
you can best do it when your patient is in the knee-chest 
position. 

4. The lack of expulsive power is sometimes due to 
the want of sleep. If the first stage, that of dilatation, is 
prolonged the subsequent uterine contractions seem to 
want efficiency. In such cases if the patient can have a 
dose of opium or morphine administered to induce sleep 
it acts favorably. Where there is nervous excitement 
particularly, the efficiency of the pains are increased if 
we give opium and first procure a period of rest. 

5. The uterus may be greatly distended and its ex- 
pulsory power thereby weakened. In such cases there 
may be a suspension of the action of the uterus for several 
hours although the labor before that had made consider- 
able progress. If pains of labor are feeble or slow or 
suspended, no harm can come to the mother or child (in 
such cases) except that the mother is compelled to bear 
them for a longer time. The only remedy that I would 
suggest is that the distention be relieved by the rupture 
of the membranes and discharge of water. If more effi- 
cient pains did not come on, then I would give a dose of 
morphine, which would either increase the pains, or give a 
period of rest. 

6. Sometimes there are vehement and cramp-like pains 
in the abdomen producing no effect that is good and ade- 
quate, caused by partial irregular or spasmodic contrac- 
tions of the uterus — usually what are called hour-glass 
contractions. If the bowels have been evacuated and 
there is no improvement, I would give one-fourth grain of 



Causes of Tedious Labor. 



iS3 



morphine which will enable the woman to go through her 
labor more easily, and perhaps quite as quickly. 

7. It is generally believed that a cord being very short 
and being around the neck of the child may protract a 
labor. I do not deny that this may possibly occur, and 
when the child's head is born, and I find that there is a 
coil of the funis on its neck I loosen it. 

8. Weakness of the constitution when the general 
health of the woman is below the natural proper standard 
may be a cause why the uterine contractions are not 
severe. But in such cases the parts are not rigid, and 
nothing more than a dose of four or five grains of quinine 
is needed to make the pains effectual. 

9. A want of irritability in the constitution frequently 
observed in fat and inactive women, or in those who are 
exceedingly timid, will sometimes be a cause of slow and 
lingering labor. Fear often lessens the energy of all the 
powers of the constitution, and diminishes or wholly sup- 
presses for a time the action of all the parts concerned in 
parturition. Attendants should endeavor to inspire such 
patients with activity and resolution, and remove all fear 
from their minds. These cases are not dangerous but I 
have often found it necessary in this kind of cases to ap- 
ply forceps. The skilled nurse might perhaps give eight 
or ten grains of quinine, if no physician has charge of the 
case. 

10. Every woman is expected to suffer greater pain 
and to have a more tedious labor with her first child, and 
if a woman be advanced in age at the time of having her 
first child the difficulty attending her labor may be some- 
what greater. A longer time may be required for the 
completion of the labor than in ordinary cases, but I do 
not advise giving any medicine unless it is perhaps a dose 



154 Mother, Nurse and Infant. 

of quinine. There may be a little more need of assist- 
ance by instruments, &c. 

n. An oblique position of the os uteri, it being pro- 
jected on one side or the other of the center of the superior 
strait, or so far backwards that it cannot be felt for 
several hours after labor has begun, is a cause of delay. 
The presenting part may be found pressing against the 
walls of the pelvis at one point, instead of keeping its 
course in the center of the pelvic cavity. You should 
endeavor to place the patient so as to remedy this con- 
dition. When the presenting part is found to one side, it 
will be found that the fundus of the womb is lying to the 
opposite side ; this should be remedied by a proper sup- 
port of the abdominal tumor or by holding it up by the 
hands. For example, if the os uteri be projected to the 
left side, she ought to rest on the right side and have a 
pillow placed under her body; some physicians would pre- 
fer that she lay on the left side, but without the pillow 
under her. 

12. Extreme rigidity of the os uteri is a cause of 
tedious and very painful labors. It sometimes happens 
that the os is dilatable, but the pains are not sufficiently 
expulsive. Perhaps at the same time the os is found far 
back towards the promontory of the sacrum, and the head 
appears not to be driven directly into the os so as to aid 
in its dilatation, but rather presses against the anterior 
wall of the cervix. In such a case the end of the finger 
can be hooked into the anterior lip of the os uteri so as to 
aid in the dilatation, and also to help correct the displace- 
ment of the os. In other cases we may help dilate the os 
by a firm and gentle sweep of the finger around the ad- 
vancing part of the child's head within the os. But 
we cannot always do this, because we may be afraid of 



Tedious Labor. 155 

rupturing the membranes prematurely. If the membranes 

have been already ruptured, we may act more boldly, but 
we must never make any great efforts to dilate it arti- 
ficially lest we excite inflammation. In many cases it is 
best to give J gr. of morphine, and inform the suffering 
woman that she cannot possibly get through her labor in 
a short time, but if you can give her an hours' rest, the 
os, which is rigid, will be more relaxed and pains more 
effectual. 

13. In first labors there is sometimes unusual rigidity 
of the soft parts, which are external. Where the perin- 
eum is rigid it may require several hours continuance of 
the pains before it is sufficiently stretched to allow the 
head of the child to pass. But the difficulty can hardly 
be relieved by our interposition. We should generally 
wait the due time, as we must also if the os coccygis is 
anchylosed with the sacrum. 

14. The head of the child may be comparatively large 
when the pelvis is of the ordinary form and size. This 
may be a cause of delay though it may perhaps cause 
nothing more than prolonged, tedious labor. In such 
cases you have time to send for a doctor, even if he lives 
at a distance. After the woman has been a long time in 
labor he will think it best to apply the forceps. 

You will be importuned in cases of slow and tedious 
labor to administer ergot, but any one who knows the 
action of the drug would never give it in any of the fol- 
lowing cases : 1. Where the os is not well dilated. 2. 
When any mechanical obstacle exists to the passage of the 
child, or when there is a tendency to convulsions, and you 
should never give ergot except for hemorrhage ; and when 
you have much reason to fear it, you may in such cases 
give one or two twenty drop doses of the fluid extract very 



156 Mother, Nurse and Infant. 

near the termination of labor. Quinine may be given as 
an oxytocic with safety. Morphine is liable to render the 
pains weak for a time, but it often increases their efficiency. 
I will now enumerate your duties when you act as ac- 
coucheur. 

1. Ascertain if the lady is really in labor. Make a 
digital examination. If the os is high up so as to be 
reached with difficulty, slightly patulous and rigid, and the 
pains are felt in front, there is reason to believe that the 
labor has not yet commenced — that she only has false 
labor pains. At this time attend to the bowels ; give 
perhaps paregoric or morphine to relieve her of what is to 
her useless and exhausting agony, and enjoin rest. You 
may at this time properly give'her an enema containing J 
of a grain of morphine or fifteen grains of chloral dissolved 
in gruel or starch or mucilage. 

2. When you make an examination and find that the 
pains are efficient in producing a dilatation of the os 
uteri, that the parts are soft and relaxed, if there is a 
secretion called the show, if there is a favorable presenta- 
tion, and the labor is making some progress, the patient 
should be told of all that is favorable in the case. 

3. Be careful in making early examinations to, first, if 
possible, reach the os with the finger. When your finger 
presses against the cervix it will hurt her considerably 
more than it will when it presses against the presenting 
part of the child. 2. Avoid rupturing the membranes. 
3. Notice if there is anything observable to hinder the 
progress of the labor. 4. Note any progress of the labor. 

4. If everything is favorable, assure the patient of the 
fact ; if you have doubts and fears upon some point, you 
need not express all your fear, but do not delay to send 
for a physician. 



Duties of Midwife. 157 

5. You may in the early stage of labor, permit the 
patient to move about as she wishes, and she may rest on 
the sofa when tired. She may have her usual diet, but 
not any stimulants. 

6. From time to time make an examination. If the 
os is dilatable you need not fear that the membranes may 
then be ruptured. Learn as fully as possible the presen- 
tation and position, and if you press your finger against 
the child's head you may thereby reinforce weak pains. 

7. Do not annoy the patient by pressing upon the 
back or anywhere during a pain if she requests you not 
to, but when she does not object you can make such pres- 
sure as will reinforce the action of the abdominal muscles. 
When she is lying on her back with her shoulders elevated 
so that she is in an almost vertical position, you can stand 
beside her with your back towards her head, and make 
the necessary palpation by pressing with your hands on 
her abdomen, one of them on each side. Do this only 
when there is no tenderness, when the os is dilated, when 
there is a normal pelvic canal and a low position of the 
presenting part. Seek in thus pressing to move the 
uterus to the axis of the pelvic brim, then with the palms 
of your hands to the sides or fundus of the uterus press 
gradually downward, increasing the pressure for six or 
eight seconds, and then gradually diminishing. You may 
repeat this as often as she has a pain, and with an increas- 
ing force, and if the patient assents, you may make such 
pressure unremitting. 

8. When the os uteri is fully dilated or soft and dilat- 
able, the membranes may be broken by pressing with the 
end of your finger against it, or if this does not suffice, 
the finger nail previously nicked may open it. 

9. When free hemorrhage occurs prior to delivery, it 



158 Mother, Nurse and Infant. 

may depend upon placenta previa ; that is, upon the 
placenta being attached very near or over the mouth of 
the womb ; in such a case obtain a physician to take 
charge of the case if possible. You may yourself give 
half a teaspoonful of extract of ergot in the emergency. 

10. During the progress of the labor you must always 
remember that the unassisted, natural powers are in most 
instances fully sufficient to bring the labor to a safe ter- 
mination, and whatever you do should be of the kind that 
is not harmful. The important thing for the attendants 
to possess is gentleness and patience, and it is a good 
thing for the patient if she can be kept tranquil and 
cheerful. 

11. A little light food may be offered the patient at 
any time during labor. 

12. During the first stage of labor the patient must 
not strain or bear down to the pains, but it is my practice 
when I examine my patient and find that the head has 
not yet entered the pelvis, at the same time that the touch 
stimulates the uterus to contract, I direct the patient to 
bear down during each pain. After the head is fully en- 
gaged in the bones, no stimulus to pain is needed ; how- 
ever, as the bearing down pains come on, she should be 
advised to strain or press down. 

13. Towards the last, when she is in great pain, if she 
be inclined to cry out, let her do so ; never reprove her. 

14. I approve of giving chloroform in some cases, but 
I do not advise the skilled nurse to give it except when a 
physician is present to direct its use. 

15. During the latter part of the labor the only as- 
sistance you can render the woman is to support the back, 
and to give her something to pull upon if she is so in- 
clined. A sheet tied to the foot of the bed may be useful 



Midwifery. 159 

for this purpose. At the very last, bearing down efforts 
should be discouraged. 

16. When the head is about to be expelled we always 
tear there may be slight or severe lacerations of the 
perineum. Do not in any way hasten the expulsion, even 
if there should be a number of pains in which a part of 
the head presents externally during the pain, and then 
recedes when the pain goes off. I have not always been 
able to prevent laceration, but the following directions are 
the best that I can give : Endeavor to have the patient 
extend her legs, and do not have her knees drawn up 
close to the body at the last. When the perineum is put 
on the stretch, place the thumb and forefinger of the right 
hand on either side of the perineum, and press so as to 
aid the stretching or distention. When the perineum is 
distended and protruding you may cover the hand with a 
soft- napkin and apply it across the perineum, also by 
the sides of the vulva, and make firm, moderate pressure 
during the pain. Endeavor to have the pressure equable 
around the head of the child. 

17. When the head is expelled an attendant should 
make steady gentle pressure upon the uterus and follow it 
down, keeping her hand firmly upon it for several minutes, 
perhaps for half an hour, or if you have - given a little at- 
tention to the child, you yourself may put your hand on 
the contracted uterus and firmly knead it for ten minutes. 

18. It is not necessary to extract the body immediate- 
ly after the expulsion of the head. It is better to wait 
three or four minutes for the return of a pain before 
making any traction. 

19. Although a little traction can be made on the 
head, it is a better way while an attendant presses on the 
uterus, and while you hold on to the child's head with one 



160 Mother, Nurse and Infant. 

hand, insert a finger of the other hand into the axilla, 
(under the child's arm) and gently extract the body. 

20. The child may be born apparently asphyxiated — 
its face swollen — and of a dark lived color, and at first 
make only feeble and gasping efforts at respiration ; if 
there is the least beating of the heart can be perceived, 
there is fair hopes of its recovery. The cord should at 
once be tied and the child removed from the mother. If 
one or two slaps on its body does not make it cry 5 try 
immediately artificial respiration by the Sylvester method 
perhaps, not omitting at first and afterwards to throw a 
little cold water on its body. If these efforts fail I would 
try to induce respiration by placing my hand over its 
nostrils and blowing into its mouth, and immediately 
afterwards compressing its lungs. 

21. As soon as the child cries, as it most generally 
will as soon as it is born, proceed to tie and separate the 
cord. Tie the cord tight, so that it is thoroughly com- 
pressed and the vessels obliterated, applying the ligature 
about one and a half inches from the child, and then cut 
the cord one inch further from the child. The child can 
be rolled in flannel and removed, and you can attend to 
the mother and to the removal of the afterbirth. 

22. In only a very few cases I have had post partem 
hemorrhage or adherent placenta to trouble me, and I 
commend to you the method that I have used for the re- 
moval of the placenta. I do not tie the cord until circu- 
lation has ceased in it. I then sever it, and usually two 
or three ounces of blood may flow from it. This I suffer 
to run into some vessel to avoid soiling the bed uselessly, 
and then wind the cord around my right hand so that I 
can hold it. If I cannot have an attendant to make 
proper pressure on the uterus, I immediately endeavor to 



Post Partem Hemorrhage. 161 

compress it as much as I possibly can with my left hand, 
but I make very little traction on the cord. J usually 
instruct some one else to make strong and firm pressure 
upon the uterus, and I pass two fingers of one hand into 
the vagina, and learn thereby when the placenta descends, 
and if necessary assist in its removal. Although we 
should never hurry in removing the afterbirth, I believe 
that it always is easily removed if we make the effort very 
soon after the child is born, and if it is necessary for you 
to pass your hand into the uterus you can do so then bet- 
ter than at any other time. Judging from my own ex- 
perience in cases of retained placenta, if you pass your 
hand along the cord into the uterus, you will find that an 
hour-glass contraction retains the afterbirth (whether ad- 
herent or not) in the fundus. You will have to press 
your fingers through the constricted portion and grasp it, 
and you can remove it steadily and slowly, but not stop- 
ping to give it " one or two turns in the vagina." 

23. Post partem hemorrhage is liable to occur ; 
when it does, obtain a physician as soon as you can, but 
some things must be done immediately. 1. Some one 
must grasp and compress the womb continually. 2. ' Re- 
move the pillows and raise the foot of the bed so that the 
patient's body lies higher than her head. 3. If you 
have it, give a small teaspoonful of extract of ergot, or 
twenty drops spirits turpentine or (F. 96.) 4. Examine 
to know if possible, the source of the hemorrhage ; if it 
comes from the vagina or perineum where there is lacer- 
ation, it is not very dangerous. Inject hot water of the 
temperature of 115 into the uterus, and apply a dry cot- 
ton cloth, heated as hot as possible, to the abdomen ex- 
ternally. 5. Before using the injections remove all clots 
from the vagina. 6. Quinine and stimulants may be 



162 Mother, Nurse and Infant. 

exhibited if there is sinking, and ice may be applied to 
the abdomen and to the internal surface of the uterus, if 
the bleeding continues. I will here direct another thing 
which is very effectual, and which might be used at first 
in preference to anything else. 7. After removing the 
clots take a handkerchief or piece of muslin, saturated 
with vinegar, in your hand, pass it entirely into the 
uterus, and let it remain there 15 or 20 minutes, and your 
hand also. Your hand will compress the open blood 
vessels, and keep a clot in the mouth of them, and the 
vinegar will act as the best astringent that can be used. 
In one case of violent flooding I simply held my hand still 
in the uterus for five minutes, and the flow ceased. After 
the hemorrhage subsides you must be careful not to raise 
the patient's head above the level suddenly ; her life may 
be put in jeopardy by suddenly raising her so that she 
sits up. 

After pains are very seldom severe in primapara 
cases, and they are less likely to be severe if the proper 
manipulations have compelled the womb to close com- 
pletely, expelling all clots, &c. But sometimes there is a 
peculiar irritability or neuralgic condition of the womb 
which gives rise to excruciating pains. Ordinarily you 
may use Tully's powder. (F. 123, 93, 95, 107.) 

Retention of urine in some cases necessitates re- 
peated visits of the physician, and he will appreciate a 
nurse who can introduce the catheter. If the patient 
cannot at first void the urine, perhaps the application of a 
hot wet sponge over the pubis may enable her to do so. 
But it may be necessary to introduce a catheter two or 
three times a day until she regains her power over her 
bladder, or until the swelling of the urethra subsides. 

It is well for the nurse to know that owing to the dis- 



Convalescence. 163 

tensible state of the abdominal parietes, the patient will 
lay twelve or fourteen hours, perhaps, after the child is 
born, without manifesting a desire to void the urine, 
though her bladder may be very full, and you should re- 
mind her of the necessity of passing the water, lest it 
produce cystitis. In some instances the urethra and neck 
of the bladder are extremely irritable, causing strangury, 
and there may be some difficulty in passing the catheter, 
but the urine must be evacuated, and afterwards it may 
be necessary to use ergot, laxatives, opiates and fomenta- 
tions. (F. 125, 126, 162.) 



CHAPTER III. 

CONVALESCENCE. 

Variations from ordinary convalescence will, 
under ordinary circumstances, receive necessary attention 
from the physician, but the skilled nurse should know as 
much about them as possible, and I here make a brief 
reference to some of them. 

The nervous shock, caused by the last pains of labor, 
in some cases is very severe. This is indicated not only 
by the exhaustion, but by the countenance which is ex- 
pressive of suffering, anxiety and oppression. The pulse 
may be very slow or unusually rapid, the breathing may 
be panting. Opium is the best remedy, and this may be 
given in small doses repeated, or a teaspoonful of para- 
goric may be given, also aromatic ammonia, and 3 or 4 
drops of spirits of camphor. 

The state of the pulse after a natural labor soon 
comes down to near the ordinary standard ; if it remains 



164 Mother, Nurse and Infant. 

above a hundred it is because there is some special cause. 
It will be quick if there are very hard afterpains, a ten- 
dency to flooding, diarrhoea or disturbance of the stom- 
ach, and it is quickened also when lactation commences. 
The lochial discharge ordinarily continues about 
three weeks, at first of pure blood mixed with coagula, 
and if good uterine contraction has not been secured, 
coagula may be expelled for several days after the delivery. 
Sometimes there is a sudden decrease of the lochia, 
perhaps on the fifth and sixth day, and at the same time 
an increased bulk of the womb, and increased frequency 
of the pulse. Apply hot fomentations to the abdomen, 
and probably some clots will be expelled, but at the same 
time give purgative enemata ; and if there is abdominal 
tenderness give an aromatic purgative and laudanum. 
(F. 108, 122). There are remarkable differences in the 

QUANTITY, QUALITY AND ODOR OF THE LOCHIA without 

any morbid affection of the uterus or vagina. But when 
the lochia are acrid, the vagina, labia and external parts 
become excoriated, and smarting or itching is caused. 
Try extreme cleanliness, frequent bathing, lead lotions, 
black wash, vaginal injections of warm water, and F.* 
178, 179. 

If the discharge ceases a few hours after birth, or if it 
continues the usual time, but in very small quantity, or if 
it is prolonged beyond the usual period, or if it is exces- 
sive at first, and if at the same time all the other symptoms 
are favorable, there is not occasion for much medicine, 
though it may be necessary to give the patient a better 
diet, possibly some tonics. (F. 174, 175). It sometimes 
occurs that the lochia is suddenly discharged in double 
quantity after the patient is permitted to sit up or walk 
about. In such cases enjoin extra rest. 



Milk Abscess. 165 

If the red discharge continues longer than usual, or if 
it return after yellow or greenish discharges, you should 
be on your guard against hemorrhage. Enjoin rest in a 
horizontal position under light clothing. 

Occasionally the lochia have a very fetid odor. 
It is not very rare to observe a very disagreeable odor in 
the lochia without any bad results, but this often indicates 
the retention and putrefaction of coagula or a small por- 
tion of the placenta or membranes. Syringe out the 
vagina freely night and morning with Labaraques solution 
or some other antiseptic wash, (F. 153) and once or twice 
a day with warm milk and water. A weak solution of 
carbolic acid 1 in 50 may be used, and it may be proper 
to throw it into the uterus. 

The secretion of milk generally becomes established 
in about forty-eight hours, and very often on the third 
day the breasts become turgid, hot and painful. There 
may, or may not, be some general disturbance, fever, chills, 
&c, but if there is it will usually be relieved after the 
milk is drawn out. It is customary on the morning of 
the third day to secure an action of the bowels, and this 
generally allays the vascular action if it is excessive. But 
very trivial causes may set up inflammation of the 
breast, and this is always liable to end in suppuration, 
which may be long continued and distressing. 

The mammary inflammation may follow exposure to 
cold, a blow or other injury on the breast, some tempor- 
ary engorgement of the lacteal tubes, or sudden and de- 
pressing mental emotions, and it often follows from fissures 
and erosions of the nipples. To prevent the formation of 
an abscess, endeavor to remove the engorgement of the 
lacteal ducts by gentle hand friction with oil or F. 209, 
202. Moderate the inflammation by giving five drops of 



166 Mother, Nurse and Infant. 

the extract Phytolacca decandra (Poke root) every two 
hours — give saline cathartics, minute doses of aconite, 
and perhaps a large dose of quinine. Keep the patient 
in bed and have the affected breast supported by a sus- 
pensory bandage. Apply hot fomentations containing a 
solution of carbolic acid, or poultices containing it, and 
the breasts may be smeared with belladonna extract rub- 
bed down with glycerine ; or belladonna liniment or oint- 
ment may be applied (F. 234). Belladonna plasters or 
diachalon plasters may be useful. Give 15 grains bromide 
potassa. 

When pus has formed notwithstanding efforts made 
to cure the inflammation, as soon as it is near the surface 
so that it can be detected by the fluctuation, the abscess 
should be opened. During the last few years careful 
surgeons have been unwilling to make any incision or 
lance even an ordinary abscess without employing some 
antiseptic method, such perhaps as the following: 

The patient's skin where the incision is to be made, is 
first to be washed in 1 to 1000 bichloride of mercury so- 
lution — hands and instruments employed in the work 
must touch nothing that is not sterilized ; hands must be 
washed in the same solution before operating — sponges 
that are used must be cleaned and stored in a 1 to 20 
carbolic acid solution, and instruments must be soaked in 
the same for 15 minutes before being used, and some 
apply a large wad of bichloride of cotton or gauze to 
catch the exuded pus. 

The following is Lister's antiseptic method which he 
first directed, to prevent the introduction of air contain- 
ing living germs : 

" A solution of one part of chrystalized carbolic 
acid in four parts of boiled linseed oil having been 



Antiseptic Dressings. 167 

prepared, a piece of rag from four to six inches square 
is dipped into the oily mixture and laid upon the 
skin where the incision is to be made. The lower edge 
of the rag being then raised a scalpel or bistoury dipped 
in the oil is plunged into the abscess and an opening 
about three-quarters of an inch in length is made, and the 
instant the knife is withdrawn the rag is dropped upon 
the skin as an antiseptic curtain, beneath which the pus 
flows out into a vessel placed to receive it, and all the pus 
should be pressed out as near as may be. For a dressing 
afterward Playfair recommends the following: About 
six teaspoonfuls of the above mentioned solution of car- 
bolic acid in linseed oil is mixed up with common whiting 
to the consistence of firm paste ; this is spread upon a 
piece of tin foil about six inches square, so as to form a 
layer about a quarter of an inch thick ; the tin-foil thus 
spread with putty is placed upon the skin, so that the 
middle of it corresponds to the position of the incision, 
the antiseptic rag used in making the incision being re- 
moved the instant before. The tin-foil is then fixed se- 
curely by adhesive straps, the lower edge being left free 
for the escape of the discharge into a folded towel placed 
over it, and secured by a bandage. The dressing is 
changed once in twenty-four hours, as a general rule, and 
must be methodically done. A second similar piece of 
tinfoil having been spread with the putty, a piece of rag 
is dipped in the oily solution and placed on the incision 
the moment the first tin is removed. This prevents 
mischief during the cleaning of the skin with a dry cloth, 
and pressing out the discharge from the cavity. 

The same author directs methodical strapping of the 
breast with adhesive plaster, in cases of long continued 
suppuration, and he adds that "much attention must be 
paid to general treatment, and abundance of nourishing 
food, appropriate stimulants and such medicine as iron 
and quinine will be indicated." 

I give on the authority of another the following as good 
treatment for sore nipples : 

" 1. Keep everything that will irritate, whether cloth- 



168 Mother, Nurse and Infant. 

ing or medicine, away from the nipple, and have the excess 
of milk drawn from the breast in the easiest way possible. 
2. Keep the excoriated nipple thickly covered with sub- 
nitrate of bismuth. 3. When the nipples are cracked at 
the base keep the cracks filled with bismuth, and put on a 
round piece of adhesive plaster starred in the centre, and 
just large enough to slip over the nipple and extend 
around its base an inch or more every way. When this 
is loosened it must be reapplied." (F. 231, 243). 

There are certain accidents of parturition so grave in 
their nature, and attended by symptoms so alarming and 
urgent that no nurse would attempt to treat the patient 
except under the direction of a physician. I only refer 
to them because it is believed that some of these serious 
cases might have been prevented by early proper action 
on the part of the midwife or other attendant. 

Inversion of the uterus sometimes occurs, though 
but rarely. If it is in the practice of a midwife, and if 
she be at the time pulling on the cord, that will be as- 
signed as the cause of the accident. Inversion consists 
essentially in the enlarged and empty uterus being either 
partially or entirely turned inside out. The immediate 
symptoms are those of shock or collapse — fainting, small, 
rapid and feeble pulse, possibly convulsions, or vomiting, 
and a cold, clammy skin. The countenance becomes 
deadly pale, the voice weak, and other symptoms indi- 
cates sudden exhaustion or sinking. In cases of partial 
inversion the symptoms are not so striking. Hemorrhage 
to a large amount, frequently but not always occurs. In 
more than half the cases no mechanical cause can be 
traced, but as it is sometimes attributed to pulling on the 
cord, to pressure with the hand on the fundus, and also 
to the patient straining forcibly, these combined causes 
should be avoided. W T hen the symptoms named are pres- 



Puerperal Septicemia. 169 

ent, you can give the patient some aromatic ammonia or 
other stimulant ; always obtain a physician as soon as 
possible. 

Puerperal mania is nearly always preceded by rest- 
lessness, want of sleep, and other premonitary symp- 
toms. When the mania first comes on there is usually 
causeless dislike to those around her, and as the child may 
be the object of suspicion, the nurse must be extremely 
careful that the patient does not have an opportunity to se- 
riously injure it. The course of treatment must be mainly 
directed to the maintenance of the strength of the patient, 
and the two things most needful are a sufficient quantity 
of suitable food and sleep. Possibly your efforts in this 
direction before the disease is fully developed, may ward 
off the disease. 

Puerperal septicemia was formerly called puerperal 
fever ; as its nature is now better understood than former- 
ly, we hope to do more than was formerly done to prevent 
it. This fever is now very generally believed to be pro- 
duced by the absorption of septic matter into the system, 
through some tear or laceration in the generative tract 
such as exists after labor. 

This septic matter may be from within the patient such 
as coagula, or membrane, or placenta partly decomposed ; 
or from without as might be on the hands of physician 
and nurse, or in the air from cases of erysipelas, &c, or 
in some way from puerperal patients. 

The notion that puerperal fever and septicemia is pro- 
duced by bacteria has now become an established doc- 
trine, and has given rise to a rational treatment based 
thereon, especially for their prevention. 

As prophylactic means may be mentioned, the use of a 
carbolic solution 1 in 30 which the practitioner or nurse 



170 Mother, Nurse and Infant. 

applies before touching any case, the use of carbolized oil 
i in 8 for lubricating the fingers, catheter, forceps, &c; 
syringing out the vagina with diluted Condy's fluid, rigid 
attention to cleanliness in napkins, &c. The nurse should 
use antiseptics to only a very limited extent without the 
advice of a physician. 



CHAPTER IV. 



CARE OF INFANT CHILDREN. 



Infants sometimes require treatment for ailments either 
slight or severe when the advice of a physician cannot be 
obtained. 

The naval is sometimes a little sore after the naval 
string comes away. It may be dressed by putting a little 
simple cerate or vaseline or carbolized cosmoline on lint 
or a linen rag, and applying it to the part affected every 
morning, and a bread poultice every night until it is quite 
healed. 

A rupture of the naval is sometimes caused by 
much crying, and it may be occasioned by the nurse pull- 
ing on the cord to remove it before it will readily sepa- 
rate from the infant's body. 

The best treatment is a piece of adhesive plaster as 
large as the top of a tumbler, with a properly adjusted 
pad made of several folds of muslin fastened on the plas- 
ter, which will keep the bowels from protruding. The 
bandage or belly band can be put on over this. 

If the infant have a groin rupture the only proper 
treatment is to keep on it day and night if it cry much, a 



Care of Children. 171 

well fitting truss. In applying the truss be careful to re- 
turn the rupture thoroughly, and endeavor to have it well 
adjusted or it will chafe and will not effectually cure. 

If the child is tongue tied so that it cannot apply its 
tongue to the nipple to suck, the frenum may be cut, but 
it will not be necessary to make more than a small nick 
or a slight cut in it. 

Milk in the breasts of new born infants, or a 
serous fluid resembling it, is often found, and sometimes 
there is considerable swelling both of the breasts of male 
and female children. It is not the better way to apply 
plasters or to squeeze or press them, but the milk may be 
drawn out by putting an open top thimble over the nip- 
ple and drawing on it. 

Chafings may be caused by inattention to cleanliness. 
Fat babies are subject to them, and when there is disorder 
of the bowels or kidneys they cannot at all times be pre- 
vented. Thoroughly sponge the parts with tepid rain 
water, allowing the water from a well filled sponge to 
stream over them, then carefully dry with a soft towel, 
and perhaps dust over them sub-nitrate of bismuth. 
(F. 202.) 

Diarrhcea and dysentery and also costiveness are 
among the ailments with which infants may be afflicted. 
I wish to be particular in giving directions, that these 
may generally be avoided, but I must again repeat that 
the nurse should never be influenced by my advice to do 
any thing contrary to the directions of the attending phy- 
sician. 

To avoid the subsequent necessity of giving medicine 
you must be very careful in their administration at first. 
It is indeed necessary that the meconium should be 
purged off at first, but nature in general provides such 



172 Mother, Nurse and Infant. 

physic as is required, and if the child is applied to the 
mother's breast, it obtains in the colostrum such medicine 
as it needs. Where the infant cannot obtain anything 
from the breast a gentle aperient may be given, and I 
name the following as being suitable: either molasses and 
water, raw sugar, a solution of manna in warm water, a 
teaspoonful of sweet oil, or of simple syrup of rheubarb, 
or in more obstinate cases, of castor oil, or one-fourth 
teaspoonful compound licorice powder, (F. 122) but you 
must never give a drastic purgative, and you must not 
repeat the aperient if the discharges become yellow and 
natural. A young infant ought to have from three to six 
motions in the twenty -four hours, the color ought to be 
of a bright yellow or orange, and of the consistency of 
mustard as ordinarily prepared for the table, and there 
ought not to be any lumps or curds in its motions. A 
mother or nurse ought to be very observant of the state 
of the bladder and bowels — should inspect motions daily 
and see that they are not slimy, or curdled, or green. If 
they are she should be very careful, especially in regard 
to what the mother eats and drinks. If the bowels are 
costive she must avoid the frequent repetition of opening 
medicine, however gentle and well selected the aperients 
may be. They interfere with digestion, often irritate the 
bowels, and render them more costive. For the sake of 
the child as well as herself, the mother may vary her diet 
considerably after the first week, she may eat boiled and 
stewed, broiled and .roast meats, mutton, lamb, and beef, 
fish, game, and chickens, potatoes, turnips, spinach, celery, 
peas, beans,*figs, bananas, prunes, baked apples, &c. (F. 
45 to 60.) The bowels of the child that nurses generally 
(not always) keep pace with those of the mother, and .she 
must endeavor both for her own sake and that of the 



COSTIVENESS. 173 

child, to keep her bowels loose by means of diet. If 
necessary she must take "physic. (F. 107, 108, 109.) 

If the constipated child nurses the mother and the 
mother constantly pays proper attention to her own 
health, and especially to her diet, the child will very sel- 
dom require physic. Indeed I would not give active physic 
when the child seemed well, if it did not have a passage 
oftener than once a week. If it has cow's milk or other 
food besides the mother's milk, do not boil the milk and you 
can add to the cow's milk, corn starch, or the following : 
Make a thin mush by boiling a small quantity at a time 
of unbolted wheat flour in water and straining it through 
a sieve while hot. The child may sometimes be fed with 
this alone, a little sweetened. Molasses may be given 
freely, or molasses and soda. The child should be 
watched, and if there is occasional costiveness, and at the 
time any indisposition, make a suppository of common 
soap about an inch in length and a quarter of an inch 
thick, dip it in water and pass it into the rectum. Or 
give an injection of less than a gill of water with perhaps 
a teaspoonful of molasses and a pinch of salt. But I 
would avoid the practice of giving an enema daily, as tend- 
ing to get up a bad habit in the system. Should the cos- 
tiveness have provoked fever, induced pain, or excited 
convulsions, active physic may be given, either castor oil, 
magnesia, calomel, or F. 108. But be sure that costive- 
ness is not brought on by giving paregoric or other 
opiates, and let a child drink freely of pure cold and 
fresh water. The water may be boiled to destroy germs, 
and then cooled in a refrigerator ; it should always be 
boiled before being used when there is an epidemic of 
bowel complaint prevailing. 

In dysentery there is a specific inflammation and 



174 Mother, Nurse and Infant. 

ulceration of the mucous membrane of the colon, espec- 
ially of the lower part, and of the rectum — there is gener- 
ally some fever, frequent and bloody stools, tenesmus, and 
griping pains. Sometimes it attacks an infant or a deli- 
cate child, there being at first for several days diarrhoea, 
the motions being slimy and frothy like frogspawn, after- 
ward entirely mucous and blood. The child is dreadfully 
griped, strains violently, and screams, and twists about 
every time it has a motion, and there is vomiting and 
great prostration. 

You should in treating the child at the breast still keep 
him to it, and give it no other food. If the mother's milk 
is not good, procure if possible a healthy wet nurse. If 
the child must be fed give it cow's milk from one healthy 
cow — fresh from the cow — small quantities at a time and 
frequently, mixed with gum arabic water. In the com- 
mencement a warm bath may be used, or as a substitute 
you may wrap the child in a blanket that has been pre- 
viously wrung out of hot water ; over this put a dry blan- 
ket and keep the child thus enveloped for twenty or thirty 
minutes. 

Formula 74 and 99 may be used, but the dose for a 
young child must be small to accord with its age. 

Cholera infantum is more prevalent in the United 
States than in any other country. The continued heat of 
summer is a predisposing cause, and improprieties in diet 
and clothing, worms, premature weaning, and teething are 
exciting causes. 

You may treat this disease in the initial stage by giving 
F. 80, and also for a child a year old, injections of a gill 
of warm water in which a teaspoonful of common salt has 
been dissolved, allowing the patient three or four times a 
draught of warm water, as much as it desires to drink. 



Care of Infan i - 175 

Perhaps the drink will be immediately vomited, but it 
will at least remove irritating matter from the stomach. 
The injection, too, may operate immediately, but it may 
bring with it a fecal or bilious discharge, and if several 
times repeated, its effects will be salutary. A muslin 
cloth heated almost to scorching and applied once or 
twice dry to the neck, may stop vomiting, and draughts 
applied to the extremities may also be of much benefit. 
After using injections of warm soft water, anodyne injec- 
tions may be given three or four times a day; but cases 
of this kind are too serious for any nurse or mother to 
treat, if the services of a physician can be obtained ; and 
I will only mention one or two things more. When the 
extremities are cold put the child for a few minutes in a 
warm bath of mustard water, and then employ friction to 
the skin. 

I have found chicken tea made by boiling the chicken 
very soon after it is killed, very useful in checking the 
vomiting and curing the child. 

Of course a physician will be obtained in these serious 
cases if possible. 

Retention of urine in the newly born infant if slight 
is easily removed by giving two or three drops of spirits 
of nitre once an hour in a little sweetened water, or if 
obstinate it may be aided by castor oil and the warm bath. 
A little pumpkin seed or parsley root tea also succeeds 
remarkably well. • 

Apth/E is usually called the baby's sore mouth. It 
generally begins on the inner part of the lower lip or cor- 
ner of the mouth, as a small white speck which resembles 
a coagulum of milk. These apthuous white pustules soon 
appear over the inside of the cheeks and on the tongue 
and gums. The eruption is very white and looks as if 



176 Mother, Nurse and Infant. 

whey or curds were spread over the mouth, which is hot 
and painful, and the disease sometimes does, and at other 
times does not cause fever. I regard this complaint as 
being one of the germ diseases, although the fact has not 
yet been demonstrated. The children fed upon farina- 
ceous food are most liable to this disease, and during its 
continuance, if the child is not at the breast it should be 
kept entirely to the milk of one cow. Medicine should 
be given with regard to the stomach and bowels. If the 
passages from the bowels are green, magnesia is a proper 
kind of physic, and when there is diarrhoea use formula 
80, 77, 81. 

Genuine jaundice may attack a young child, but this 
is to be distinguished from those cases where there is only 
a generally diffused yellow color of the skin. In the 
latter class of cases there are no symptoms indicating any 
serious disease ; the yellowness may continue for several 
days, and this disappears without the aid of any medicine 
and without leaving any evil behind. But in jaundice 
the whites of the eyes and the tears are tinged yellow, 
and, besides, the feces are paler than they should be, 
the urine is yellow, and other serious symptoms are added. 
If the bowels be costive, or irritated to frequent efforts, 
if the abdomen swells and becomes tense, if the child is 
uneasy and inclined to vomit, if it refuse the breast and 
frequently moans as if in pain, if it emaciate ' rapidly, 
jaundice in a bad form is present, and there is probable 
disease of the liver. Call the doctor. 

I need not continue my instructions any farther in re- 
gard to the diseases of infancy, as you are expected to 
act as far as you can under the directions of a physician. 
But I must again advise you as to how you are to treat 
your medical advisor. Give him your entire confidence. 



Difficult Labor. r77 

Be truthful and candid with him. Have no reservations ; 
give him a plain statement of the symptoms. Be prepared 
to state the exact time the child showed any illness. Tell 
him if the child had a chill ; if there be any eruption on 
the skin, note the quantity and appearance of the urine, 
the number, color, &c, of the stools — all the symptoms of 
the disease. Strictly obey the doctor's orders in diet, in 
medicine, in everything, and never omit any of his sug- 
gestions. If the case be severe, never call a second phy- 
sician without first consulting and advising with the one 
first chosen ; speak in the presence of children with re- 
spect and reverence of the doctor, and endeavor to have 
them like him. Send for the doctor when practicable 
early in the morning, as the daylight is most favorable for 
making the examination, but if the illness come in the 
night do not delay on that account ; if you do not know 
what to do, it is better that the doctor be called early 
than late. 



CHAPTER V. 

CASES OF DIFFICULT LABOR. 

I wish to give you so much instruction in regard to 
cases of difficult labor that you may at least be prepared 
to decide in any case when the services of a physician is 
indispensably necessary, to decide whether the parturition 
in a given case is a natural one that does not need any 
assistance, or an unnatural one requiring the assistance of 
the art of midwifery, scientific or manual, for the relief of 
irregularities and difficulties. In general I shall adopt 
Churchill's divisions and definitions as I think they are 
very concise and correct. 



178 Mother, Nurse and Infant. 

tedious labor. 

"Definition. The head of the child presents and the 
rabor is terminated without manual or instrumental assis- 
tance, but it is prolonged beyond twenty-four hours from 
causes which occasion delay in the first stage." 

Prolongation of labor is of comparatively small conse- 
quence when the membranes are still intact, as they serve 
to protect the soft parts of the mother as well as the body 
of the child from injurious pressure, but the mere length- 
ening of the labor may become a serious thing when the 
head has entered the pelvis, when the uterus is strongly 
excited by reflex stimulation, and when the maternal soft 
parts as well as the foetus and cord are exposed to severe 
pressure. When we find no evil resulting from the delay 
we need not interfere, but when we can remove the cause 
of it we are bound to do so. 

In tedious labors the woman becomes fatigued, the loss 
of sleep is much felt, her spirits become depressed, and 
the stomach is more or less disturbed, but when the other 
bodily functions are performed regularly, the skin is cool, 
the pulse quiet, the tongue clean and moist, there is no 
headache, and the pains recur tolerably regularly, the 
condition of the patient is favorable, though the pains are 
inefficient and vary in their duration and frequency. 
There is usually loud outcry during the pain in the first 
stage of labor, but there is often sufficient remission of 
the suffering for the woman to get some quiet sleep, and 
generally there is progress to the labor. 

Inefficient action of the uterus occurs most 
commonly in women confined for the first time, and 
sometimes we can ascribe it to no cause but constitutional 
peculiarity, or a deranged state of the digestive organs, or 



Tedious Labor. i 79 

mental depression ; in other cases it may be caused by 
irritation of the os and cervex uteri. 

The skilled nurse may properly send for a medical man, 
though he is not indispensably necessary in such cases. 
The best thing which she can give in such cases is a 
quarter grain dose of morphine to suspend the pains and 
induce sleep, or if this is not thought best it may be proper 
to give physic or stimulating enemata. Never give ergot 
to increase the pains, but it may be proper to give several 
grains of quinine. However, giving medicine must be 
left as much as possible to the physician. 

Excessive amount of liquor amnii with undue dis- 
tention of the uterus in some cases renders the pains in- 
efficient. The unusually large size, and the fluctuation of 
the abdominal tumor may be obvious, but although an 
accoucheur might deem it advisable to evacuate the 
waters, the skilled nurse who could not be certain that 
there was a favorable presentation, should not do it. She 
must exercise patience herself and encourage the patient 
to do so, and time will probably do the work, though it is 
better to commit the case to a doctor. 

An undilatable os uteri, which remains rigid al- 
though the pains are severe, may sometimes be felt with 
its edges thin and stretched over the head, and sometimes 
thick and tough. In the majority of cases patience and 
time may overcome the obstacle, but as it is best in some 
cases to give chloroform, chloral, &c, and in some in- 
stances to use local means to relax or dilate the os, the 
physician should be sent for. The nurse may properly 
give the patient a hip bath. 

Premature escape of the liquor amnii and ob- 
liquitv of the uterus are both causes of tedious labor, 
but not cause for apprehension or special interference. 



180 Mother, Nurse and Infant. 

I have already given some hints in regard to the treat- 
ment of the latter class of cases. 

The posterior lip of the cervix uteri in some 
instances is retracted while the anterior is drawn 

TIGHTLY OVER THE CROWN OF THE HEAD. In SUch 

cases it has been my practice to draw with my finger the 
anterior lip forward, and during the time of the pain to 
press my finger against the head of the child. I do this 
believing that the anterior lip is caught between the head 
and symphasis pubis, and that it will be better retracted 
while support is given to the head. 

POWERLESS LABOR. 

" Definition. The labor is prolonged in the second 
stage by causes which act on the uterine powers primarily 
or secondarily, rendering the pains feeble and inefficient 
or totally suppressing them." In consequence of the 
stage at which the delay takes place, certain symptoms 
arise which render speedy delivery imperative. 

The second stage may continue twenty hours or more 
without any bad symptoms, but usually if it exceeds 
twelve hours some of the following symptoms may be ob- 
served: The pains become irregular as to recurrence 
and force — perhaps become weaker— there may be rigors 
or shiverings — the vomiting may be distressing — there 
may be constant restlessness and fever — the vagina and 
uterus may be hot and tender to the touch — and the 
pressure of the child's head may prevent the evacuation 
of the bladder. The same causes (weak constitution, 
mental emotion, disease, &c), which in the first stage 
rendered the labor tedious without bad symptoms, now 
occasion these and perhaps even more alarming indications. 
If an experienced accoucheur now arrives to take charge 



Obstructed Labor. 181 

of the case he will be likely to apply the forceps, hut it 
would have been better if he had been there and applied 
them sooner, before the patient had undergone so much 
suffering ; and the midwife who attends a woman in the 
first stage of the labor should ascertain if any of the fol- 
lowing causes of powerless labor exists: Is there a weak 
constitution or one exhausted by disease ? Is it a first 
labor and the woman of advanced age ? Has the patient 
had very many children ? Is there excess of liquor 
amnii ? Is there malposition of the uterus ? No mid- 
wife should undertake to manage such a case alone. 

OBSTRUCTED LABOR. 

" Definition. The progress of the labor is impeded 
by some mechanical obstruction in the passages connected 
with the soft parts, which by causing delay in the second 
stage leads to the developement of symptoms of powerless 
labor." 

The symptoms that arise and that cause anxiety are the 
same as in a case of powerless labor, except that while in 
the latter kind the pains are feeble, in the case of ob- 
structed labor the pains may be vigorous and severe but 
ineffective in consequence of obstacles. I may say, how- 
ever, that these obstacles have not been often met with in 
my practice. Since I commenced the practice of mid- 
wifery three thousand cases of pregnancy have been under 
my observation for treatment, and I have not yet met 
with any of the following causes of obstructed labor: 
Occlusion of the os uteri, cancer of the os uteri, undi- 
latable vagina, tumors in the pelvis, or diseased ovary, 
stone in the bladder, imperforate hymen, hernial protru- 
sion into the vagina, or blood effusions, or swelling of the 
soft parts. I have met with one case of excessive cede- 



182 Mother, Nurse and Infant. 

matous effusion of the vulva, which I relieved by punc- 
turing the skin ; one case of cystocele which I relieved by 
first drawing the water and then returning the bladder, 
before the head of the child descended into the pelvis ; 
one case of ovarian tumor that was not at that time in 
the pelvis ; one case of small fibrous tumor on the neck 
of the uterus, which did not much obstruct the labor ; 
and numerous cases where hardened feces in the rectum 
was an obstacle until they were removed by the use of 
enemata. In cases of obstructed labor the skilled nurse 
will show her wisdom by detecting the obstructions and 
sending for an accoucheur. 

DEFORMED PELVIS. 

" Definition. The progress of the labor impeded by 
abnormal deviations in the form of the pelvis, giving rise 
to delay in the second stage, or rendering the descent of 
the child impossible without assistance, or altogether im- 
practicable. The symptoms are those of powerless 
labor." 

The equally enlarged pelvis, enlarged in all its 
parts, is not often met with, and is of no obstetric impor- 
tance. If in any case this condition is diagnosed preced- 
ing or during labor, the patient should be watched by the 
nurse lest labor close so precipitately that the child falls 
to the ground. 

The equally contracted pelvis — equally contract- 
ed in all its diameters, generally renders the labor diffi- 
cult and tedious but not impracticable, by the natural 
powers. Other distortions such as has often been caused 
by rickets, &c, offer great obstruction to the passage of 
the child. In some cases a modification of the position 
of the child allows it to descend, but in many cases it is 



Malposition and Malpresentation. 183 

necessary to interfere and terminate the labor artificially. 
The nurse should not wait for unfavorable symptoms to 
appear before she sends for a man that is able to use the 
forceps, (S:c. 

malposition and malpresentation of the child. 

Unnatural or abnormal labor may be caused by some 
peculiarity on the part of the child, in the position or 
presentation. These cases demand the services of the 
skilled accoucheur, and I do not intend to hint that the 
nurse should ever attempt to do what an educated phy- 
sician should be called to do in these cases. 

Face presentations sometimes retard the labor so 
much in the second stage as to give rise to unfavorable 
symptoms. In cases where the action of the uterus is so 
energetic as to finally expel the child, the sufferings of 
the mother are severe and prolonged. I have in my 
practice met with four cases, three of which were deliv- 
ered by the natural powers, the children living ; in one 
case craniotemy was performed. The mothers all lived. 
The diagnoses of face presentations is not easy at an early 
stage of labor. The finger first touches the forehead, 
which may be mistaken for the vertex. When the mem- 
branes are ruptured we may be able to make out the pre- 
sentation. We may distinguish the edges of the orbits, 
the prominence of the nose, the mouth, &c. The bridge 
of the nose is the best guide, it being prominent, firm, 
and unlike any part of the breech or vertex. The face 
becomes tumefied during the labor, and the cheeks pressed 
together to resemble the nates, and it may be mistaken 
for a breech presentation. But in either presentation the 
proper course for the nurse is to leave the case alone in 
the expectation that the natural efforts will be sufficient 



Mother, Nurse and Infant. 184 

to complete delivery. The child when born has a fright- 
ful appearance from the swelling and discoloration of one 
cheek, &c, but the injuries pass away in a day or two. 

The forehead towards the arch of the pelvis at 
the time of delivery is not favorable, but unless the pelvis 
is proportionately small no interference is necessary. 

The breech may present at the brim in different posi- 
tions, and the breech is distinguished by its roundness 
and softness, by the cleft between the buttocks, by the 
arms and by the organs of generation. In some cases the 
labor is concluded as quickly as if the head descended, 
in others it is more tedious. The results as regards the 
mother are as favorable as in head presentations. The 
danger to the child is in direct proportion to the length of 
time between the birth of the body and that of the head. 

When the body is expelled so far as the umbilicus, the 
danger to the child commences, for at this time the cord 
may be pressed between the body of the child and the 
pelvic walls. A loop of the cord should be pulled down, 
and if it freely pulsates the child can probably be deliv- 
ered alive. Generally a judicious traction on the part of 
the accoucheur, combined with firm pressure through the 
abdomen applied by an assistant, will effect delivery of 
the head before the delay has had time to prove injurious 
to the child. If the arms of the child are above at the 
side of the head, the doctor will bring one down by pass- 
ing a finger over the shoulder as near as possible to the 
elbow, and then drawing it across the face and chest until 
it arrives at the external orifice, but all this time it is the 
part of the nurse to continue to make effective pressure 
upon the abdomen of the mother — also while he delivers 
the shoulders— and while he perhaps introduces two fin- 
gers into the vagina of the mother to reach the upper jaw 



Presentation of the Knees. 185 

of the child and make pressure upon it, so as to depress 
the chin and facilitate the expulsion of the head. 

Presentation of the knees and presentation of 
the feet is identical in its progress with breech cases, 
and the treatment of breech cases applies to footling pre- 
sentations, but it is best to avoid pulling on the foot or 
feet that come down, as it is safer for the child if the 
lower part of the body is delivered quite slowly. Even if 
the nurse should in an emergency deliver the child, she 
should help principally by pressure on the mother's ab- 
domen. 

The only rule that I would have the skilled nurse adopt 
in regard to these cases, is that it is necessary that she 
should discover as early as possible if the labor is not a 
natural one, and if it is unnatural, should obtain the ser- 
vices of a physician as soon as possible. The same rule 
applies to cases of placenta previa hemorrhage, but I 
shall have more to say of these hereafter. A case of 
compound presentation where the hand and arm presents 
with the head, or in which the. feet and hands, or one of 
each present together, also imperitively demand the ser- 
vices of an experienced accoucheur without delay. The 
nurse will be impotent to give any efficient help until the 
doctor arrives. 

Presentation of the superior extremities will receive 
from me a full and complete description, because I believe 
that under certain circumstances the nurse should be pre- 
pared to operate by turning. As this radical opinion may 
perhaps be opposed by my medical brethren, I offer the 
following reasons for it which I consider a sufficient justi- 
fication. 

1. Cases of this class commence with the ordinary 
symptoms of labor; their peculiar character cannot usually 



186 Mother, Nurse and Infant. 

be distinguished until the os is well dilated, and this is 
the only favorable time to perform the operation of 
turning. 

2. Although in cities and villages generally, a phy- 
sician's services can in most instances be immediately 
obtained, in the country it is not always practicable to 
obtain them within an hour or two of time. 

3. Such knowledge as is necessary for the perform- 
ance of this operation may be obtained from such des- 
cription and instruction as can be given in books. 

4. There are some women who possess the necessary 
traits of character, the complete exercise of their facul- 
ties, with the perfect coolness which is demanded of the 
operator in such a case. 

5. I do not advocate trusting the operation to a nurse 
when the services of an accoucheur can possibly be ob- 
tained within the proper time. 

6. The services of a physician, if obtained one or two 
hours after the arm is first thrust down in the vagina, may 
not be of any use because the time for turning is passed. 

7. The operation of turning, performed by a properly 
instructed nurse, does not involve the least danger to the 
mother or child. 

8. The only danger connected with this operation 
arises from the size of the hand of the operator, and the 
woman's hand is small. 

9. It is a historical fact that at one period practition- 
ers overrated the performance of turning, and extended 
its use to unsuitable cases, and after the invention of the 
forceps, they fell into an opposite error. It is possible 
that we may be in error if we hold that the nurse cannot 
be instructed to perform the operation of turning. 

10. I do not advise that the nurse should ever attempt 



Presentation of the Hand. 187 

to turn in those cases in which the membranes have been 
long ruptured — the shoulder and arm pressed down into 
the pelvis, and the uterus contracted around the body of 
the child. I once succeeded in a case that two expe- 
rienced physicians had tried in vain for several hours to 
turn, and I never had very much difficulty in turning, but 
there have been many cases where excellent operators 
could not succeed in turning. 

In cases of presentation of shoulder, arm or 
trunk, delivery by the natural powers is quite exception- 
al, though the natural powers have occasionally succeeded 
in expelling the child. The safety of the mother and 
child depend upon the early detection of the abnormal 
position of the foetus, and upon their receiving proper 
treatment before labor has been long in progress. 

The position of the child is one intermediate between 
the long and transverse diameters. It may lie with its 
back towards the abdomen of the mother or with the back 
towards the spine of the mother, and the head of the 
child may be towards the right or the left of the mother. 

The existence of a shoulder presentation is not com- 
monly suspected until the first examination is made during 
labor. Suspicion will arise from finding on examination 
that we are not able to reach the presenting part, and that 
the os uteri does not dilate as usual, and that when it be- 
comes dilated the bag of membranes protrude of a coni- 
cal form, but this is common to all malpresentations. 
When the shoulder has descended a little it is recognized 
as a round, smooth prominence, rounder than the elbow, 
and we may be able to reach the axilla, &c. The elbow 
may be recognized by the sharp prominence of the bone, 
and the hand can be distinguished from the foot by the 
fingers being wider apart and more readily separated 



188 Mother, Nurse and Infant. 

from each other than the toes, and by the thumb which 
can be carried across the palm. The situation of the 
thumb and the aspect of the palm of the hand will mark 
whether it is the right hand or the left. 

As soon as the nurse ascertains or suspects from an 
external palpation or a vaginal examination, that it is a 
cross birth she should send for the doctor, who ought to 
be there as soon as the membranes are ruptured, and the 
nurse must not be very persistent in making examinations 
lest she rupture the membranes prematurely. She may 
perhaps give a small dose of morphine, but I would not 
advise that she give chloroform as it is not necessary. 

The right time to turn the child is when the os uteri is 
dilated, either before or immediately after the rupture of 
the membranes, and if a doctor cannot be soon obtained, 
it is better that a skilled nurse should turn the child, and 
if she is properly instructed, she should do it carefully 
and slowly, but without any fear and confidently. She 
can assure the patient that she will be able in a short time 
to relieve her sufferings. 

In England the ordinary position for turning is on the 
left side. I prefer that the patient be placed across the 
bed on her back with her legs drawn up and supported 
by assistants. I now describe my own mode of operating. 

I bare my right arm and hand (sometimes the left), 
lubricating it freely. If the waters have only recently 
escaped, and the os be dilated, the operation is performed 
with ease, especially after we have determined the posi- 
tion of the child. 

I press the fingers together in the form of a cone, the 
thumb between the fingers — slowly and carefully press 
them into the vagina in an interval between the pains, 
and constantly and slowly press the hand in, only when 



The Operation of Turning, [89 

the contractions of the uterus remit ; never using any 
force, gently pass the fingers into the os ; gently open the 
fingers a little occasionally to dilate the os sufficiently, 
and when it is expanded pass the hand into the uterus, 
make out the presentation accurately, so as to keep my 
hand to the abdomen of the child ; always keep the hand 
still during a pain ; when there is an interval between the 
pains, carefully search for the feet ; when one of the feet 
is found, clasp the leg at the knee with one finger ; flex 
the leg at the knee so that the finger has a good hold of 
it, draw it down in the absence of a pain ; as the knee 
approaches the os when it is drawn down over the abdo- 
men of the child, the shoulders and head recede towards 
the fundus, and when the head has reached the fundus 
and the knee is brought through the os, the case is con- 
verted into a knee presentation, and I deliver slowly but 
without needless delay — making a little traction during 
each pain, the management being conducted as in feet 
presentations, and the whole process being assisted by 
pressure made on the uterus by my left hand, or by the 
hand of an assistant. 

Possibly these directions will be better understood if I 
use the language of another who directs : 

1. That the patient be placed on her left side near the 
edge of the bed. 

2. The os externum is then to be dilated with the fin- 
gers reduced into a conical form, acting with a semi rotary 
motion of the hand. 

3. When the hand is passed through the os externum 
it must be slowly conducted to the os uteri. We may 
perforate the membranes with the finger if they are not 
broken. 

4. The hand must then be passed along the thighs and 



190 Mother, Nurse and Infant. 

legs of the child until we come to the feet. If both the 
feet lie together we must grasp them firmly with one hand, 
but if they are distant from each other we may deliver by 
one foot. 

5. Before we begin to extract we must be sure that we 
do not mistake a hand for a foot. The feet must be 
brought down with a slow, waving motion into the pelvis, 
when we are to wait till the uterus contracts, still retain- 
ing them in the hand. 

6. The feet are to be brought down with each return 
of the pain, and the labor may be finished partly by the 
efforts of the mother and partly by art. 

7. If the toes are turned towards the pubis the back 
of the child is towards the back of the mother which is 
an unfavorable position. 

8. If the toes are towards the sacrum, the back of the 
child is towards the abdomen of the mother, and this 
position is advantageous when the head comes to be ex- 
tracted. 

9. When the feet of the child has passed through the 
os externum, wrap them in a cloth and holding them firm 
wait till there is a pain, during the continuance of which 
gently draw down the feet. When the pain ceases we 
must rest, we merely assisting the efforts of the patient. 

10. When the child is brought so low that the funis 
reaches the os externum, a small portion of it is to be 
brought out to slacken it, and from this time the opera- 
tion is to be finished as speedily as it can be with safety, 
but if the circulation of the funis be undisturbed, there is 
no occasion for haste as the child is in safety. 

11. If the child should stick at the shoulders the arms 
must be successively brought down. 

12. When both the arms are brought down the body 



The Operation of Turning. 191 

of the child must be supported upon our Left arm and 

hand, the fingers on each side of the neck, and if the 
head should not come easily away, we must introduce the 
forefinger of one hand into the mouth of the child to 
render the position of the head more convenient for 
passing. 

12. When a child, has been extracted by the feet, the 
placenta usually separates very easily, but in the manage- 
ment we are to be guided by the general rules. 

13. In these cases the child usually needs to be recus- 
sitated, and the nurse should arrange so that hot and cold 
water may be at hand if required. 

In these descriptions of the operation I have mentioned 
both the back and side as good positions for the mother, 
because some accoucheurs prefer one position and some 
the other. Some prefer to have the patient on the hands 
and knees. But if the nurse have the instructions here 
given well in her mind, she can operate in either position. 
If she ascertains at first how the child lies she may some- 
time reach its abdomen better if she introduces her left 
hand,- but the main point is to proceed slowly and care- 
fully. She should be careful in passing in her hand to 
change the direction of it in accordance with the pelvic 
axis, and should not use much force at any time. The 
danger to the mother is very small indeed ; the danger to 
the child arises, as in breech presentations, from the com- 
pression of the funis, which commences about the time 
the buttocks appear at the os externum. But the safety 
is only when the operation is performed at the proper 
time. The nurse must never operate if the services of a 
physician can be obtained at that time, but when it is 
necessary she may proceed to turn, doing it slowly and 
properly, but fearlessly and confidently. If the doctor 



192 Mother, Nurse and Infant. 

that is sent for is informed before he arrives that it is a 
case of hand presentation, he will come dreading the dif- 
ficulties that he may encounter, and if he can have the 
satisfaction of knowing when he comes that the woman is 
safely delivered, he will be exceedingly glad. 



CHAPTER VI. 

CONCLUDING INSTRUCTIONS IN MIDWIFERY. 

What I shall say of plural births, and monsters, of 

CHILDREN AFFECTED WITH HYDROCEPHALUS, OR ASCITES, 
Of EXCESSIVE SIZE OF THE FCETUS, of DEFECTS IN THE 
FORMATION OF THE FCETUS, of PROLAPSE OF THE FUNIS, 

cs:c, will be compressed in a few words. I am not in- 
structing the nurse to attempt to conduct a case of even 
natural labor without having a physician if he can be ob- 
tained, but she should consider the services of a trained 
practitioner imperatively necessary in these unusual cases. 
In either instance there may be a safe delivery by the nat- 
ural powers alone, and the nurse may act in an emergency, 
but it would not be consistent with the plan of this work 
for me to describe in detail the various operations that are 
sometimes performed in these several cases, or to give in- 
structions in the use of instruments, which I advise the 
nurse never to use. 

In regard to those instances where it seems as if it 
would be necessary to use instruments, I quote the fol- 
lowing rules adopted by accoucheurs : 1. Meddlesome 
midwifery is always bad. 2. In no case need we inter- 
fere when the obstacles to be overcome can be overcome 



Placental Presentations. [93 

in a reasonable time by nature or without an operation. 
3. Cases in which instruments are to be used arc excep- 
tions to the general rule, and no instrument should be 
used in a clandestine manner. 4. We should not have 
such an aversion to the use of instruments that we too 
long delay that assistance we have the power of affording 
with them. 

PLACENTAL PRESENTATION. 

Placenta previa will never be treated by the nurse, 
but she should know its nature, know that it is this that 
causes unavoidable hemorrhage, and she should not fail 
to obtain a skillful physician early, to attend the case. 
The flooding is the necessary consequence of the dilata- 
tion of the os uteri, by which the connection between the 
placenta and uterus is separated, and the more the labor 
advances, the greater the disruption, and the more exces- 
sive the hemorrhage. 

The woman usually passes through the early part of 
pregnancy without any sign that denotes the peculiar at- 
tachment, but the placenta can easily be distinguished 
from the membranes or coagulated blood as soon as the 
os uteri is a little opened. When a hemorrhage comes on 
from this cause the patient is never free from danger till 
she be delivered. Often the medical man is obliged to 
free the patient from imminent danger by artificial deliv- 
ery, but I can conceive of no circumstance in which a 
nurse would be justified in turning for unavoidable hem- 
orrhage. 

Before, during, and after the delivery, the appliances 
used in other cases of hemorrhage may be used with some 
advantage, but I would hardly advise the nurse to do any 
thing before the doctor arrives. 



194 Mother, Nurse and Infant. 

accidental hemorrhage. 

That form of flooding that arises from a partial and 
accidental separation of the placenta which occupies its 
usual position, must here be briefly referred to, as the 
nurse may be called on to do something in an emergency. 
The immediate cause of the flow is the separation of some 
portion of the placenta from the womb, and the lacera- 
tion of the vessels. The hemorrhage is at first internal, 
is accompanied with dull pain at the spot where it takes 
place, it generally becomes external, it may or may not be 
attended with the discharge of coagula from the os uteri, 
and when the discharge commences it varies in quantity 
from a few ounces to an amount that is alarming. It is 
generally necessary to make a digital examination, to dis- 
tinguish the accidental from the unavoidable hemorrhage. 

Until the doctor arrives the patient should be kept in 
bed on a hard mattrass and very lightly covered with bed 
clothes. The temperature of the room should be kept 
very low, and nothing but cold water allowed. 

The danger from hemorrhages that occur at or near the 
full period of utero gestation, may often be estimated by 
the absence or degree of pain, as well as from the quan- 
tity of the discharge. Hemorrhages are much more dan- 
gerous with sudden than with slow discharges of blood, 
and women are always in greater danger when they are not 
accompanied with pain. Puerperal convulsions, whether 
of the hysteric, epiliptiform, or apoplectic variety will 
always demand and almost always receive the prompt 
attention of the physician. 

While the nurse is waiting for the doctor to arrive she 
might possibly administer a cathartic, thirty grains of 
bromide of potash, and an enema, but as a general rule 



Accidental Hemorrhage. 195 

she should not give anything. She might insert a wedge 
or roll of linen between the teeth to prevent injury to the 
tongue, and she should remove every thing out of the 
way, by striking against which, the patient might hurt 
herself. 



PAl^T V. 
^Etiology, Symptomatology, Medication, Nursing. 



CHAPTER I. 



CAUSES OF DISEASE. 



The causes of disease are spoken of by authors as pre- 
disposing, and exciting. By proximate cause of disease 
is meant the cause of the symptoms present ; this cannot 
appropriately be dwelt upon here. 

By exciting cause is meant the immediate cause of a 
disease, and the distinction from predisposing cause arises 
from the fact that when two persons are exposed to some- 
thing injurious to the health, they may not be equally 
affected. 

It has been said that if twenty persons undergo hard- 
ship and exposure from shipwreck, the effect of the wet 
and cold may be in one to cause catarrh, in another rheu- 
matism, in a third pleurisy, in a fourth opthalmia, in an- 
other inflammation of the bowels, and fifteen may escape 
without any illness at all. A predisposing cause is defined 
to be anything whatever, which has had such an influence 
on the body as to have rendered it unusually susceptible 
to the exciting cause of the particular disease. In most 
cases the distinction is obvious, but it is sometimes diffi- 
cult to say of a given cause whether it ought to be ranked 
among the predisposing or the exciting causes. 



Causes of Disease. 197 

I >isease is often warded off notwithstanding the presence 
of the exciting cause, when we ascertain and prevent the 
predisposing cause of it, and it may sometimes be averted 
in despite of strong predisposition, if we know and can 
guard against the agencies by which it is capable of being 
excited. 

When we enumerate causes of disease we see among 
them many that under ordinary circumstances minister to 
life, health, and enjoyment ; and I can hardly refer at all 
to the varying circumstances under which they become 
the medium of pain, disease and death. These circum- 
stances are so various, so many of them are apt to be put 
in operation at the same time, and so little power have we 
of excluding them one after the other, so as to ascertain 
the exact efficiency of each, that our observation respect- 
ing their actual effects are open to much fallacy. 

We cannot for instance in a given case estimate accu- 
rately the effect of impurities in the atmosphere such as 
organic and inorganic dust, nor the effect of differences 
in degree of its natural qualities such as extremes of heat 
and cold, sudden variations of temperature, excessive 
moisture or dryness, different electric conditions, differ- 
ences of pressure, a deficiency of light, and the amount 
of ozone, &c. 

OF HEAT AND COLD AS EXTERNAL AGENCIES CAUSING 

DISEASE. 

The range of temperature compatible with human life 
is very great ; men live in the hottest and the coldest cli- 
mates, where the earth produces any sustenance for them. 
It requires more care to preserve life under intense cold 
than under intense heat. Tropical climates are thickly 
peopled where the thermometer ranges from 8o c to ioo c 



19S Mother, Nurse and Infant. 

for a long time together. In arctic countries on the other 
hand where the thermometer sinks to 40 or 50 below 
zero, we still find inhabitants, but they are few and thinly 
scattered. It is probable that at a degree of temperature 
a little greater than that of the equator or a little less than 
that of the poles men would perish. 

Man is capable of existing under certain circumstances 
for a short time, and enduring a much higher degree of 
heat than the general atmosphere attains in the hottest 
portions of the earth, but there are generally some dele- 
terious effects from hot climates or continued hot weather. 

The effect of heat is to stimulate the organic functions 
of the body, but when considerable heat is applied for 
some time together its effect is to cause languor and las- 
situde, want of energy, a disinclination for exertion both 
bodily and mental ; it has a depressing effect generally up- 
on the animal functions or the nervous system, and there 
are some forms of disease that are distinctly traceable to 
heat as a cause. 

We all know the effect of hot weather in causing per- 
spiration, and when the operation of high temperature is 
continued for some time it has a marked influence upon 
the liver, increasing the quantity of bile that is secreted, 
and altering its sensible qualities ; this is sometimes fol- 
lowed by inflammation of the liver. 

In this country those attacks of vomiting and diarrhoea 
which are so common towards the latter end of summer 
or in autumn are the effects of a succession of hot days. 
In tropical climates the morbific effects of external heat 
are still more conspicuous, tending to violent disorders of 
the stomach and intestines, and also to acute inflamma- 
tion of the liver and to acute abscesses in that organ. 

In these cases the heated atmosphere unduly stimulat- 



Effects of Cold. 199 

ing the secreting function of the liver creates the predis- 
position to the disease, while the exciting cause of the 
inflammation may be exposure to cold. 

There may be deleterious effects from exposure to cold 
where the climate is quite hot. For instance a man may 
after the heat occasioned by the employments of the day, 
undress and lie opposite a window, his shirt wet with 
perspiration, to enjoy the sea breeze at night, and though 
the thermometer may be as high as 8o c he may have a 
sensation of cold. If there is real chilliness it may be 
deleterious. 

Heat sometimes acts as an exciting cause of disease — it 
produces sunstroke, or it may produce an eruptive disease 
such as prickly heat, &c. 

The effect of extreme cold (I use the term cold in the 
popular acceptation), when its application is continued, is 
that of a sedative upon the organic functions. Though 
at first causing pain in the extremities, if continued it 
causes sleep or overpowering drowsiness. Before this 
complete stupor comes on there may be a blunting of the 
sensations and confusing of the intellect, giving to the 
person exposed to it, the appearance of one intoxicated. 
When persons in this state are suffered to sleep, and the 
operation of the cold continues, they become less and less 
sensible to external impressions until death closes the 
scene. 

But the effect of cold upon the body within certain 
limits of intensity and duration is that of a tonic. When 
its refrigerating and sedative properties can be sufficiently 
counteracted by exercise and warm clothing, cold is stim- 
ulating, refreshing, and invigorating to mind and body, it 
clears and sharpens the faculties, bestows alacrity and 
cheerfulness of spirits, and may become a curative agent. 



200 Mother, Nurse and Infant. 

Yet exposure to cold is one of the most common causes 
of various complaints. As a rule it is true that there is 
danger from sudden vicissitudes of temperature, although 
the proposition requires limitation. No peril need attend 
a change from a hot to a cold temperature if the power to 
evolve heat inherent in the system be entire and active 
and persistent, not lessened by any of those circumstances 
which have the effect of weakening it, such as local 
disease, and fatigue. Cold is dangerous, not especially 
when the body is hot, but when it is cooling after being 
heated. At such times taking a large draught of cold 
water, or cooling the body suddenly some other way 
might cause death immediately ; if not, an inflammation 
of some internal part of the body might arise. 

Every thing that has the effect of weakening the system 
and so diminishing the power of evolving heat, favors the 
morbific effect of cold, and is a predisposing cause of 
disease. The most common of these debilitating circum- 
stances are fasting, evacuations, fatigue, a last night's 
debauch, excess in venery, long watching, much study, 
and rest or inaction immediately after it, or after great 
exercise. 

The faculty of evolving heat is weak in old persons and 
in the newly born, and these are often the victims of the 
power of cold. 

The bad effects of cold depend very much upon the 
duration of the sensation. Even slight feelings of chilli- 
ness, if long protracted, are apt to terminate in some form 
of disease. 

Cold is more likely to prove injurious when it is applied 
by a wind or currant of air, and the injurious operation of 
cold is augmented when it is accompanied with moisture 
— wetness is the worst way in which cold can be applied. 



Cold and Damp. 201 

The contact of wet or damp clothes with the skin, both 

increase and prolong the sensation of cold. A foggy 
atmosphere is more prejudicial than a clear one of the 
same temperature. While we are asleep, also, our power 
of resisting the effects of cold is diminished. 

The power of habit enables a person to resist the effect 
of cold, and we may sometimes turn our knowledge of it 
to good account in gradually fortifying the system against 
the influence of cold that cannot be avoided. But we 
must not, while we fear to render our children effeminate 
by over care and much clothing, run into the opposite 
extreme and endanger their health by exposure. The 
process of hardening is doubly dangerous when it is at- 
tempted with children who were originally delicate, and 
should never be tried on any child or any person who is 
unsound, who shows any signs of present or approaching 
disease, or any marked predisposition to future, and es- 
pecially to scrofulous disease. 

An abiding sense of chilliness must never be permitted 
even when we are endeavoring to accustom a child to 
cold. If they can be kept in the cold air, and at the same 
time be kept feeling warm either by exercise, diversion of 
the mind, or by clothing, the result as regards the health 
is good. 

The cold bath, and especially the shower bath, is a 
good means of fortifying the body against cold air. When 
we take a cold bath in the morning, if the sense of cold does 
not remain long, and is followed by a glow of warmth, the 
bath is sure to do good. If, however, after the bath we 
suffer headache, and continue to be chilly and languid or 
uncomfortable, it should at once be given up as useless 
and dangerous. 



202 Mother, Nurse and Infant. 

effects of the season upon health. 

In this country, generally, catarrh and coughs and pec- 
toral complaints of all kinds, are most apt to prevail in 
the winter and spring months, while bowel complaints are 
more numerous and distressing in the summer. The 
mucous membranes of the air passages sympathize with 
the skin under the agency of external cold ; those of the 
stomach and intestines under that of heat. 

The thoracic disorders which commence or grow worse 
in the winter are often fatal, and there are various other 
maladies that are aggravated by cold, so that the mortality 
of winter is greater than that of summer. Bowel com- 
plaints are more prevalent at the latter part of summer or 
early s fall, when moderately cold days succeed a long 
period of hot weather, the high diurnal temperature being 
the predisposing cause, and the cold exciting or bringing 
on the disease. 

I shall not refer to other causes of disease except to 
say that if two persons marry each other who have a 
hereditary predisposition to disease, their children, if they 
have any, will probably not be healthy. 



CHAPTER II. 



SYMPTOMS OF DISEASE, WITH INSTRUCTION TO NURSES. 

Symptoms are the signs by which we know that disease 
is present. Every circumstance happening in the body 
of the sick person capable of being perceived by himself 
or others, which can be made to assist our judgment con- 
cerning the seat or nature of the disease, its probable 
course and termination or its proper treatment, is a sign 
or symptom. 

These phenomena are the evidence upon which the 
whole art of the physician proceeds. It is important that 
the nurse should know how to note the symptoms, not 
only that she may know how and report to the doctor 
changes that occur in his absence, but that she may be 
able also to minister to those who are suddenly attacked 
with sickness, and to judge whether in cases of slight in- 
disposition it is necessary to send for a physician. 

By arranging and comparing symptoms, and by noting 
the circumstances under which they occur, the physician 
can distinguish the disease, and learn what are the indi- 
cations of treatment — this belongs especially to him. 
But it is very important that a nurse should know how to 
note all changes as they occur, and sometimes it is best 
she should keep a written record of them. An important 
point in a trained or skillful nurse is that of her ability to 
observe accurately and describe intelligently what comes 
under notice in the absence of the physician. She should 
cultivate the habit of strict observation, and simple and 



204 Mother, Nurse and Infant. 

truthful statement — neither deficient, exaggerated, or per- 
verted, stating facts and not opinions. 

Symptoms or phenomena which accompany disease 
may be subjective, those which are evident only to the 
patient, or objective which are observable by others. Both 
sorts of symptoms shed mutual light on each other, and 
as the statements of the patient are not always trust- 
worthy, the nurse should be careful not to let anything 
pass unseen that can by vigilance be noted. 

The following directions will help the nurse to cultivate 
the habit of observing symptoms : 

Try to learn all you can of the previous history of the 
case; you will sometimes get information which the patient 
would not be likely to communicate to the doctor in 
person. 

Note the patient's apparent age with any indications of 
disguised age, signs of weakness — whether corpulant or 
bloated ; note any deformities, swellings or wounds, and 
notice the attitudes and expression of the countenance. 

A sufferer instinctively takes the position most con- 
ducive to ease. When one lung is affected the patient 
lies on that side, that the healthy one may have the greater 
freedom of motion. When there is peritonitis (inflamma- 
tion of the bowels), he lies on his back with his knees 
drawn up to relax the abdominal muscles. If there is 
colic alone he may lie on the abdomen, as pressure may 
relieve his pain When a patient has been persistently on 
his back, if he turns onto his side it is a sign of improve- 
ment. 

Inability to breathe termed orthopncea, occurs in 
affections of the heart, and also in asthma. Lying quietly 
in bed is usually a favorable sign. Restlessness and slip- 



Symp roMS of Disease. 205 

ping to the foot of the bed, in low stages of fever, are bad 
signs. 

Of the uneasy, morbid symptoms, pain is the most im- 
portant, and most common. Pain occurs in nearly all 
inflammations, and it may occur where there is no inflam- 
mation at all. 

Bones, muscles, tendons, ligaments, the bladder, the 
kidneys, the uterus, all modify in a manner that is pecu- 
liar to themselves the pain that is produced by injury or 
disease. Such terms as the following are used to express 
a peculiar character of pain : It is said to be sharp, shoot- 
ing, growing, burning, dull, heavy, tearing, and so on. 

If pain is felt in any part when pressure is made upon 
it the heightened sensibility is called tenderness, the 
part is said to be tender. A part may be both painful 
and tender, as it usually is if the pain continue for a time ; 
it may be tender without being painful as it is usually, if 
pain continued for a time and then ceased. 

Itching is an uneasy sensation allied to pain. It often 
affects the natural outlets of the body. It occurs about 
the rectum from the motions of little worms that nestle 
there, and other causes ; and this itching of the rectum, 
and likewise of the pudendum, are distressing complaints, 
harassing the patient continually, preventing sleep and 
requiring medical treatment (F. 195). The tingling and 
pricking often felt in the windpipe, and provoking cough- 
ing, has some analogy to itching. 

Nausea is sometimes a direct symptom of gastric dis- 
order, at other times it is a very important indirect result 
of disease at some distance from the stomach. The 
nausea which is so troublesome to pregnant women, is an 
instance of a morbid sensation, sympathetic of irritation 
in a distant organ. 



206 Mother, Nurse and Infant. 

Dizziness or vertigo results sometimes from disease 
within the head, and sometimes it is the indirect result of 
disease of the stomach or of mere debility. 

A sensation of sinking, sensations of weight and light- 
ness, of drowsiness, tenesmus, strangury, heartburn, and 
various conditions of the special senses are mostly sub- 
jective symptoms. 

One of the first symptoms of diabetis is a preternatural 
keenness of appetite, but in most diseases the appetite is 
lost or impaired or perverted. 

Thirst is generally great in diabetis, and there is com- 
monly considerable thirst in inflammatory complaints. 

The above named symptoms are mostly subjective, but 
are accompanied by others that are objective, that show 
that the functions of certain parts are disturbed or sus- 
pended ; and it is of especial importance to notice the 
pulse, as this is a valuable guide in treating disease. 

Each contraction of the heart sends out a wave which 
distends the blood vessels, and they by their contractility 
or elasticity carry it on through the entire arterial system. 
This periodical distention is the pulse. 

The pulse beats can be felt wherever an artery ap- 
proaches the surface ; it is usually taken and counted at 
the wrist ; in children it can be best taken at the temporal 
artery during sleep. 

To take the pulse accurately place two or three fingers 
on the artery making moderate pressure, and note partic- 
ularly its frequency, its regularity, its forces and its 
fullness. 

The rate varies with varying circumstances. The 
average number of pulsations in a healthy adult is from 
70 to 75, but there are some persons who, when they are 
quite well have a pulse of 80 or 90 to the minute, and 



The Temperature. 207 

there are others in whom it seldom rises above 60. It is 
usually more rapid in women than in men, is much more 
frequent in early life than in old age, and the average 
rate in a healthy child is 120. 

In disease, the pulse may acquire a great degree of 
frequency. It may reach 150 or even 200, but in such 
cases it is generally feeble and can hardly be counted. 
Besides observing the frequency of the pulse, its character 
in other respects must be noted. 

Irregularity of the pulse generally indicates 
disease, and there are two varieties of it. In most in- 
stances of irregular pulse, succeeding beats differ in 
length, force and character ; in the other variety a pulsa- 
tion is from time to time left out ; the pulse is said to 
intermit. 

In the dicrotic pulse a secondary wave or undulation 
can be felt. It is often met in typhoid fever, and an in- 
experienced person might be led to count double the 
number of beats. 

Another important quality of the pulse is its hardness 
or compressibility. The hard pulse ordinarily, though 
not always, indicates inflammation. This hard pulse may 
be known by pressing pretty hard with one finger, while 
we observe with the others whether we arrest or abolish 
the pulse. 

A pulse is said to be full or large if it is felt to strike a 
large portion of the finger ; other departures from the 
normal standard are spoken of as soft, quick, or sharp, 
throbbing, bounding, thready, wiry, flickering, &c. 

of the temperature. 

The normal standard of the temperature of a healthy 
person is 98.4°. There is some variation, and indeed a 



2o8 Mother, Nurse and Infant. 

daily cycle of variations, so that in the morning it is 99 or 
at least 98J and in the evening 97^, but the range is small, 
and if the variation is more than that, it is indicative of 
disease. There is only a deviation of about 15 ° within 
which life can be sustained ; a temperature of more than 
107 or less than 93° will almost certainly prove fatal. 

Every mother who can, as well as every nurse, ought to 
own a clinical thermometer, as thereby she may detect 
the beginning of a disorder before there are other marked 
signs of indisposition. She should use it upon the first 
suspicion of a departure from health and frequently after- 
wards, until she knows that the temperature is normal. 
An increase, especially if beginning each day a little 
earlier, is a bad indication ; a decrease from a high tem- 
perature each day is a sign of improvement. In pneu- 
monia and generally in such disorders as are initiated 
with a chill, the rise is sudden and rapid. 

In typhoid and some other fevers, the elevation is slight 
at first and gradually rises. The exacerbations and re- 
missions or other deviations can only be recognized by 
taking the temperature frequently, and it should be taken 
at the same hour each day to exhibit the cycle of changes. 

An irregularity of temperature in the course of a disease 
that has a regular type may indicate a complication, or it 
may depend upon local causes, such as constipation, bad 
air, &c. The decline of fever and of temperature may be 
gradual, or it may drop to a steady normal within a few 
hours. 

Before using the thermometer the index must be thrown 
down to a point below the normal. Hold it with the bulb 
down and shake till it falls sufficiently. 

The part (the axilla) should not have been exposed 
for washing for at least half an hour before taking the 



The Respiration. 209 

temperature, and it is a good precaution to keep the 
axilla (or mouth) closed for ten minutes before putting 
the bulb of the thermometer into it, and a little time may 
be saved by slightly warming the bulb in the hand before 
its introduction. If we are careful and see that the axilla 
is first dried from perspiration, and that the clothing is 
not in the way, and that the thermometer is held firmly in 
position a sufficient time, we may get a correct axilary 
temperature, unless in a very emaciated person. If taken 
in the mouth the lips must be closed during the process. 
The rectum gives the most reliable temperature, and 
this method is employed for infants. The thermometer 
should be oiled and introduced for about two inches. 
Unless the presence of feces prevent, the thermometer 
will be half a degree higher than if taken in the axilla. 
It will sometimes take ten minutes or more to obtain the 
temperature, but some thermometers will do the work in 
less than five minutes. 

THE RESPIRATION. 

That respiration and circulation are intimately connec- 
ted, and that whatever modifies the pulse usually effects 
the breathing is a fact generally known. That the proper 
performance of the function of every organ in the body 
depends somewhat upon proper respiration, is a fact not 
so generally known and recognized, and as this is an im- 
portant topic we may properly here enlarge upon it. 

By the muscular action of the diaphragm and intercos- 
tal muscles, and the consequent contractions and expan- 
sion of the lungs, the alternate inspirations and expira- 
tions are produced which we call breathing. The lungs 
are not completely filled and emptied by each respiration, 
and a certain amount of air remains stationary in them. 



210 Mother, Nurse and Infant. 

Were this air which remains stationary constantly in a 
particular portion of the lungs, the same without change, 
we would derive no benefit from that portion of the lungs. 
Practically, however, it is believed that the additional sup- 
ply breathed in and out is diffused through and alters the 
character of the whole. 

A healthy adult ordinarily breathes about eighteen 
times per minute, taking in each time about twenty inches 
of air. It is said that it takes at this rate sixteen respira- 
tions to completely renovate the air. This is probably 
true of our ordinary breathing, but the renovation of the 
air depends upon our manner of breathing. It is possible 
for us to breath so that at one expiration we almost dis- 
place the air from every portion of our lungs, and then 
by a full, deep, prolonged inspiration, (throwing forward 
the chest, throwing back the shoulder, and keeping the 
body erect,) fill the lungs fully with air and thus not only 
change the air in our lungs, but change in some degree 
the character of our blood so as to increase its purity. 

In order to test this let me ask anyone who is suffering 
from any slight indisposition, if it be headache, nausea, 
pains in different parts of the body, or any sickness, to 
try to breathe in this manner for half an hour, and ob- 
serve if they do not feel better, being careful at the same 
time that the air breathed is good and pure. This point 
is of so much importance that I will refer to it again 
hereafter. 

The character of the respiration is an important diag- 
nostic symptom and should always be noted. The rate 
of respiration varies as does that of the pulse, but the 
former is partly under the control of the will. The 
respirations are more rapid in women than in men, in 
children than in adults ; it is modified also by position, 



The Air. 2 1 1 

exertion, excitement, and other conditions. We may 
count the respirations by observing the rise and fall of 
the chest, but it is well to put our hand on the stomach 
where the motions may be felt. 

Breathing is in man mostly abdominal, in woman mostly 
thoracic, but inflammation in the chest or abdomen will 
affect its character. 

Dyspncea, difficulty of breathing, arises when from 
any cause the amount of air entering the lungs does not 
correspond to the amount of blood sent by the heart for 
purification. The air may be unfit for its work, or disease 
in the lungs, or air passages may shut it out. Asphyxia 
results if the supply of air is in any way cut off. 

OF THE AIR. 

In this connection I will say to the nurse, give the 
patient pure air. Learn how indispensable this is to life, 
or health, or comfort ; how indispensable to any person, 
and especially to the sick ; how liable the air in the room 
is to be contaminated by the air breathed or expired by 
those in the room ; by lights burning in the room ; by 
exhalations from the bodies of the sick ; by excreta left 
for a time in the room ; by the inevitable floating dust 
from the floors and walls ; from clothing, bedding, and 
furniture ; and from the presence of organic matter in 
increased quantity, and of most deleterious quality in and 
around the sick. 

A thousand feet of air space where the air is constantly 
renewed, is necessary for a healthy adult ; a sick person 
should have two or three times as much, because with 
them there is increased susceptibility to draughts. Be 
very careful that the sick are not placed so that a direct 
current of air can blow on any part of the bod)', but 



212 Mother, Nurse and Infant. 

either by the use of fans or in some other way the air 
must be renewed around their bed. 

VENTILATION. 

The problem to be solved is, how can fresh, pure air be 
best supplied ? The inequalities of temperature within 
and without the room produces some natural ventilation, 
as this sets the air in motion and effects an exchange of 
air, if there are some apertures around the doors and 
windows. 

This, however, is seldom sufficient, and artificial venti- 
lation is often necessary. An open fire is a good apparatus 
for this purpose. The draught which it creates carries 
the air from the room up the chimney, while a fresh sup- 
ply is drawn in to take its place. This supply should be 
from the outward air, or from an adjoining room in which 
the air is not contaminated. 

The inlets and outlets for air should be of equal capa- 
city, on opposite sides of the room, and of different 
heights to secure thorough ventilation. They should be 
as far as possible from the patient and from each other. 
In cold and damp weather great care is necessary to keep 
the air fresh and wholesome and at the same time to avoid 
chilling the patient. But even in cold weather the doors 
and windows may be thrown open for a minute at a time, 
if the patient is at the time protected by additional 
clothing. 

However, during the night and in cold and wet weather, 
the principal supply of air will be from an adjoining room, 
air that is warmed, but it should be as pure as possible. 
When the weather is cold, and especially the latter part 
of the night, have more heat in the room and not less 



Ventilation. 213 

fresh air ; if needed give your patient additional clothing 
and foot warmers. 

The windows may be thrown open once or twice a day 
in cold weather, if the patient is protected by putting ad- 
ditional clothing on the bed, and using some sort of a 
screen, (an umbrella may be used for a screen), as a pro- 
tection from the cold and direct draughts. But as the 
contamination of the air continues, the purification of it 
should be equally so, and some fresh air must constantly 
be admitted — some device used for the purpose. The 
window may be raised two or three inches and the aper- 
ture closed with a board, then the air will find admittance 
through the opening between the two sash ; or when the 
window is raised three inches, a board six inches wide 
may be placed on the window sill a little inside of it ; thus 
there will be an aperture both at the top and bottom of 
the lower sash. Or the upper sash may be lowered a lit- 
tle. The current of air which comes in (this is usually 
the lower one) should be directed upwards. 

In the summer a lamp may be kept burning in the fire- 
place or grate ; flues must in some way be kept heated or 
they will not draw. Stoves assist ventilation to some ex- 
tent, but furnaces and radiators do not assist at all to 
ventilate, and the air is thereby especially dry. A pan of 
water may be kept boiling in the room, or perhaps merely 
setting on the stove, or a towel or two may be hung near 
a radiator and kept constantly wet ; these will dampen the 
air by evaporation, and this is often necessary when the 
rooms are kept warm by artificial heat. About 66° is a 
proper temperature for a sick room in most cases, but 6o° 
to 65 ° is suitable for fever cases ; feeble and emaciated 
persons require a temperature of 70 to 75 °. 

Be careful to have the room warm when the patient is 
out of bed. 



214 Mother, Nurse and Infant. 

the symptoms of inflammation. 

The ordinary symptoms which characterize inflamma- 
tion may be known if we observe what takes place when 
an external part is injured. Let us suppose that a healthy 
man has a piece of glass stuck in his arm. He soon has 
pain, then redness in that part of his arm, then swelling, 
which is hard near the injury, and increases so that some 
swelling may be observed, though not so hard at a little 
distance, and the part is quite tender and hot. 

These are the ordinary symptoms of inflammation : 
pain, redness, heat, and swelling, with tenderness that is 
manifested when the part is pressed. 

If the inflammation increases there are signs of disorder 
in other parts of the body ; the patient may be first chilly 
and feeble, then the skin may become hot and dry all 
over the body, the pulse fall hard and frequent, lassitude 
comes on with headache, perhaps pain in different parts 
of the body ; he has also other symptoms of fever ; is 
restless, sleeps ill, loses his appetite, his tongue becomes 
white, his mouth is dry, he is thirsty, the secretions of the 
body are diminished, has what is called inflammatory 
fever, or sympathetic fever, or pyrexia, the last term be- 
ing now most generally used. 

These phenomena, this inflammation, ends in two or 
three different ways. If measures have been taken for 
subduing the inflammation — in the supposed case of the 
arm — if the glass has been removed, it will probably hap- 
pen that the symptoms above named will disappear. This 
is to end in what is called resolution. 

When the inflammation goes on until pus is formed it 
is said to end in suppuration. The symptoms grow 
more severe for several days, the swelling at length as- 
sumes a more pointed form, the skin in its centre begins 



Symptom of Inflammation. 115 

to look white, and the swelling there gets softer ; there is 
throbbing pain, perhaps the patient has chills or rigors ; 
then when the swelling is cut open or the cuticle breaks a 
yellow creamlike fluid is poured out which is pus, and 
there is generally an abatement of the symptoms. If, 
however, the suppuration or discharge of pus continues 
for some time, other symptoms are manifested such as 
frequent shiverings, followed by flashes of heat which end 
in perspiration ; this is hectic fever. 

When the inflammation is still more intense it some- 
times ends in mortification, the part dies by the vio- 
lence of the disease, the red color changing to a livid or 
purplish, or greenish black hue, the flesh losing its sen- 
sation and having an offensive odor. 

Of course inflammation may be in an organ or structure 
that is internal, and we determine the seat of the disease, 
partly by the character of the pain. Sometimes the pain 
is sharp and piercing ; this is its character generally in 
serous membranes such as the pleura or peritoneum (mem- 
branes covering the lungs and intestines.) There is less 
pain when the inflammation is in the mucous membrane, 
or in the parenchymatous structure of organs, such as the 
lungs, liver, and spleen. 

There is generally an aggravation of pain upon press- 
ing a part that is inflamed. Pain caused by air distend- 
ing the bowels and stretching the nerves may be relieved 
by pressure. Spasmodic contractions of the muscles will 
cause pain without much tenderness. 

OF HEAT AS A SYMPTOM OF INFLAMMATION. 

The temperature of an inflamed part exceeds that 
which belongs to it in health. In inflammation as in 
fever, it has been known to rise to 107 °. The increase of 



n6 Mother, Nurse and Infant. 

heat depends upon an influx of arterial blood, and there- 
fore of oxygen into the part. There is probably always 
some increase of heat, though it may not always be no- 
ticed in every case of inflammation. 

There is more redness than is natural in a part that is 
inflamed. There is more blood than usual in the vessels 
that carry red blood, and the red blood enters into the 
small vessels where the red particles cannot commonly be 
seen. All the minute vessels seem to be enlarged. The 
redness often remains sometime after the inflammation 
has ceased. 

The degree of swelling in different cases depends 
partly on the nature and structure of the part affected 
and partly on the intensity of the inflammation ; in some 
instances there is so little that it is not appreciable. 

Almost all the swelling results from the presence of 
matters thrown into the inflamed part. In the central 
hard portion the hardness is to be ascribed to an effusion 
into the areolar tissue of it, of a fluid which is transparent 
at first, afterwards becoming opaque, called coagulable 
lymph. Serum is effused into the areolar tissue of the 
softer swelling at the circumference. 

CEDEMA, DROPSY, ANASARCA. 

Even under moderate inflammation some amount of 
effusion takes place into the texture or from the surface 
of a part. This effusive serous fluid called also serosity, 
resembles and probably is the scrum of the blood. 
When this passes into the areolar structure of a part it is 
called oedema, (though this is not always by inflamma- 
tion) and if the serosity passes out extensively over the 
body, the disease is called anasarca or general dropsy- 

If a considerable amount of this serous fluid is poured 



Diagnosis of Diseases. 217 

out in a short time from the peritoneum, it is a form of 
ascites or abdominal dropsy. If it is thus poured into 
the pleura it causes apncea, or difficulty of breathing, and 
requires aspirating. 



CHAPTER II. 

DIAGNOSIS OF DISEASES IN CHILDREN, EARLY TREAT- 
MENT, &C. 

It is not often that a correct diagnosis can be made of 
a disease by a single symptom, but there are marked and 
characteristic symptoms which indicate some diseases in 
children with considerable certainty. 

A strongly marked nasal or palate sound in the child's 
cry indicates an abscess behind the pharynx. When this 
nasal tone is heard we should palpate with the finger on 
the throat to ascertain the degree of soreness. 

A long drawn, ten times lengthened, loud sounding 
expiration with normal inspiration, and no dyspnoea is 
sufficient for the diagnosis of chorea major (St. Vitus 
dance.) 

A high thoracic continually sighing inspiration, the 
upper part of the thorax doing the work of breathing, and 
with a sighing or groaning sound, shows the commence- 
ment Of HEART WEAKNESS, CARDIAC PARALYSIS OR FATTY 

degeneration of the heart, and will probably be fol- 
lowed by such symptoms as cyanosis, coldness of the ex- 
tremities, &c. - 

Strongly marked diaphragmatic expiration accompanied 
by a fine, high whistling sound, points to bronchial 
asthma. This sound, however, resembles that made in 

*T4 



218 Mother, Nurse and Infant. 

croup. If there is a pause between the end of expiration 
and the beginning of inspiration, croup may be excluded. 

Sleepiness, lasting twenty-four to thirty-six hours, oc- 
curring without fever or other disturbance to account for 
it, is an initial symptom of meningitis, though it might 
be caused by narcotics or uremia. 

A prominent, firm fontenelle means increase in quan- 
tity of the contents of the cranium-exudation of some 
sort. It cannot be caused by fullness of the vessels alone 
if it is firm and resisting. We know that we have cerebral 
disease with dropsy or exudation (Hydrocephalus). 

When the fontanelle is deeply sunken, it points to loss 
of blood or other nutritive juices, as in cholera, &c. 

A sharp, shrill cry, accompanied by an expression of 
fright or great anxiety, and occurring about an hour after 
the child has fallen asleep, is the only symptom of the 
" Alp " — night terrors, sudden awaking from bad dreams. 

Periodical crying, lasting from five to ten minutes, 
should always make us think of spasm of the bladder or 

PAINFUL URINATIONS. 

Violent crying at stool with fear of the act, and general 
avoidance of it, points to fissure of the anus, and is 
usually accompanied with constipation. 

A violent cry full of pain and almost continuous, with 
the throwing about of the head on the pillow and grasp- 
ing it with the hands, means otitis or earache. 

Weakness or immobility of the child, after a compara- 
tively slight or short illness, points to spinal paralysis. 

Delayed ossification of the cranial bones is an early 
sign of rickets, as is crying continued for weeks (increased 
on touch of the extremities), accompanied with fever and 
incessant sweating. 

Vomiting of all kinds of food continued for weeks in 



Diagnoses. 219 

children of closed cranium but with large cranial measure- 
ments, when there is no fever, pain, idiopathic disease, or 
a cerebral tumor, indicates chronic hydrocephalus with 
an acute onset. 

Congestion of the cheeks in children, excepting in cases 
of cachexia and chronic disease, indicates an inflamma- 
tion or a febrile condition. 

Congestion of the face, ears and forehead of short du- 
ration, strabismus with febrile reaction, oscillation of the 
iris, irregularity of the pupil with falling of the upper lids, 
indicates a brain affection. 

Enlargement of the spongy portions of the bones indi- 
cates RICKETS. 

A thick and purulent secretion between the eyelids may 
indicate great prostration of the general powers. 

Passive congestion of the conjunctival vessels indicates 
approaching death. 

Long continued lividity, as well as lividity produced by 
excitement or exercise, the respirations continuing normal, 
are indices of fault in the formation of the heart, 
or great blood vessels. 

A temporary lividity indicates the existence of a grave 
acute disease, especially of the respiratory organs. 

Irregular muscular movements, which are partly under 
the control of the will, indicates the existence of chorea 
(St. Vitus dance). 

The contraction of the eyebrows, together with a turn- 
ing of the head and eyes to avert the light, is a sign of 
cephalalgia (headache). 

When the child holds its hand upon its head, or strives 
to rest the head upon the bosom of the mother or nurse, 
it may be suffering from ear disease. 

When the fingers are carried to the mouth, and there is 



220 Mother, Nurse and Infant. 

besides great agitation apparent, and when it turns its 
head from one side to another, there is probably some 
obstruction or some abnormal condition of the larynx. 

A feeble and plaintive cry indicates a trouble in the 
abdominal regions. 

If the respiration is intermittent but accelerated, there 
is capillary bronchitis. In bronchitis the cough is clear 
and distinct. 

A hoarse and rough cough is indicative of true croup. 
When the cough is suppressed and painful, there is pneu- 
monia or PLEURISY. 

In diseases of the stomach, liver or bowels we have 
usually a coated tongue ; a white tongue indicates febrile 
disturbance or some throat trouble ; a brown moist 
tongue, indigestion ; a brown dry tongue, depression, 
blood poisoning or typhoid fever ; a red moist tongue, 
inflammatory fever ; a broad, pale flabby tongue ac- 
companies a dropsical condition of the system ; a 
tremulous, moist and flabby tongue indicates feebleness, 
nervousness ; a pale flabby tongue which shows the 
pressure of the teeth, a generally relaxed condition of the 
system ; the irritable or strawberry tongue with its red 
papilla, points to an irritated stomach, and is met with in 
scarlet fever ; a furred and dry tongue is indicative of 
violent local inflammation ; if afterwards clean, red 
and dry, protracted inflammatory fever. 

Wheezing cough and wheezing breathing indicates 
asthma ; dull, heavy aching pain at the base of the chest, 
•acute bronchitis ; urgent desire to go to stool, dysen- 
tery ; diminished secretion of urine, inflammatory and 
febrile disorders ; cold hands and feet, nervous dis- 
eases and low states of the blood. 

In general, the diagnosis of diseases of children is easy 



Diseases of Children. 221 

if we simply compare the objective symptoms with those 
which should obtain in a healthy child of the same age. 
But we must remember that with children symptoms which 
appear very grave are often evanescent, and on the other 
hand the indications of very serious disease may be disre- 
garded on account of their natural vivacity and recupera- 
tive powers. In each case each child should be studied 
by itself considering its antecedents, its peculiarities, its 
surroundings, and its relations to them. 

The mother has the best chance to know these ; she 
sees the child when awake and asleep, when dressed and 
undressed ; she knows its history, what has been its diet, 
what her own health has been, her own habits, her sur- 
roundings and occupations, and whether there may or 
may not have been anything to cause sickness of the child 
in her own toils or trials. The nurse and the mother 
should note all the facts, for their own guidance and for 
the guidance of the physician if he is called. 

EARLY TREATMENT OF INFANTILE DISEASES. 

Very few of the symptoms heretofore mentioned can 
be neglected with impunity. While some cases of sick- 
ness may be- left to the powers of nature to restore health, 
others require judicious early treatment, and a physician 
should be called. We should generally enjoin rest, but 
we should act by our medicines to meet every positive 
indication. 

We are the assistants of nature ; we must act by re- 
moving the causes where they can be reached ; we must 
relieve pain, but we must not by officious kindness do too 
much and interfere with the natural return to health. 
Remember that drugs are not all powerful, that time, rest, 
diet and numberless little things are the means by which 
we aid in the fight against disease. 



222 Mother, Nurse and Infant. 

It is an excellent plan not to continue medicine too 
long. Place the child on the road to health and see if it 
will not with a little supervision improve — still, however, 
using proper rest, diet, &c. 

But as the apparently trifling symptoms of to-day may 
become the full fledged attack of to-morrow, we must pay 
attention to every untoward symptom. Parents are liable 
to be unnecessarily scared, and afterwards go to the other 
extreme and neglect calling a physician until serious in- 
jury has occurred. 

I will here give you a few aphorism and general rules : 
Treatment of the sick should be according to the patient 
as well as according to the disease. Adult males are not 
so sensitive as females ; young children, whether male or 
female, are sensitive, tender and excitable, and alive to 
every irritation. But young children differ in their con- 
stitution, and some have peculiarities or idiosyncracies so 
that medicines of ordinary activity act very powerfully or 
even violently. 

Small children are always sensitive to the action of 
medicine, and small doses only are required for them. 
And in consequence of the activity of the vital powers, 
and the quickness and force of the circulation, there is a 
remarkable susceptibility to inflammatory action, disease 
sometimes running on rapidly to organic and incurable 
mischief. 

In treating children employ the mildest remedies at 
first, and aid their action by regimen. When an emer- 
gency demands, use those articles which experience has 
shown to have power to meet such an emergency. Ex- 
hibit such medicine in the minimum dose and increase or 
repeat until the desired effect is produced. Be very care- 
ful not to fill the child with nostrums for some imaginary 



Incipient Inflammation. 223 

ill, lest you thereby make it ill. Always remember that 
the first step in treatment is to change the conditions 
which produced the disease — remove the cause and assist 
nature to repair the injury. 



CHAPTER IV. 

TREATMENT OF INFLAMMATION IN ITS INCIPIENT STAGES. 

Usually the nurse or the mother does not treat disease, 
or administer medicine except under the direction of a 
physician, and it is not always necessary for her to know 
the principles that guide in their administration, or why 
particular medicines are given. But it is sometimes 
necessary for the nurse or mother to decide what shall be 
done, and to act before the doctor can be consulted. 
Accidents and emergencies occur, distress and sickness 
may suddenly attack some member of a family at any 
time, and little ailments are complained of every day by 
some of them ; the question arises, what shall be done ? 

It is not necessary every time to send for the physician, 
and he cannot at a moment's notice be obtained. For 
many ailments the mother prescribes, and many times the 
early and judicious use of medicines or regimen not only 
relieves present suffering, but also prevents the develope- 
ment of serious, and protracted and dangerous maladies. 
This is especially true in regard to incipient inflammation, 
and I shall here speak particularly of its treatment. 

What has heretofore been said about inflammation 
gives us some guide to enable us to know whether the 
case calling for our care is one of an inflammatory char- 
acter. If the pulse is full and hard and a little more 



224 Mother, Nurse and Infant. 

frequent than usual, and there is restlessness and some 
pain we may conclude that there is irritation that pre- 
cedes inflammation at least, before such symptoms as de- 
pression, chilliness followed by heat, headache, a furred 
tongue, loss of appetite, and apparent weakness come on. 
But if any of these symptoms are present we should 
search for the cause. Perhaps if the inflammation is ex- 
ternal we shall be able to ascertain what produces the 
trouble. In every case we ought to know the cause if 
possible, as we thus have more clear indications for treat- 
ment. 

But we may use the sedative treatment in all cases 
where these symptoms come on in a person who has pre- 
viously been healthy. Of course you will not bleed — 
that, if done at all, should be done by the doctor. But 
all sources of irritation ought to be removed, so that the 
patient may enjoy perfect quiet ; the sick room should be 
ventilated, and kept at the temperature of about 6o° ; let 
the diet be light ; allow ice and cold water freely, and if 
there is much febrile excitement use sedatives and saline 
refrigerants. The best sedative is veratrum viride, and 
the following is a convenient way of administering it : 
Drop 30 drops of the fluid extract of veratrum in 30 tea- 
spoonfuls of water and give 1 teaspoonful every two hours. 
To adult subjects if there is considerable fever two drops 
of the extract, or two teaspoonfuls of the diluted prep- 
aration may be given at first and the dose may be repeated 
in an hour, but it will not be best to continue such large 
doses. Aperients may be given if there are fecal accumu- 
lations in the bowels. Although quinine is a tonic, six to 
ten grains of it are sometimes given with good effect in a 
case of inflammation. 

Opium is a good remedy judiciously given ; one dose 



Treatment of Inflammation. 225 

(1 grain for an adult) is good in a case of catarrh or cold ; 
successive doses are necessary in a case of peritonitis or 
enteritis, but this should be given on a physician's advice. 
It acts probably by quieting the nerves — by sustaining 
the faltering action of the heart, and by keeping the in- 
flamed part at rest. Sometimes cold, and sometimes hot 
applications are made to inflamed parts, and it is said that 
the sensations of the patient are the best criterion of their 
usefulness. Except, however, in cases of inflammation of 
the brain, and perhaps even then, I think that hot appli- 
cations are the best. When we wish to promote suppura- 
tion hot fomentations should be applied. 

Counter irritants relieve inflammation of the deeper 
parts by drawing the circulating fluid and the nervous 
energy to the surface. The milder kinds called rubefa- 
cients, produce merely local warmth and redness ; these 
may often be used advantageously. Mustard applied so 
as to redden the skin is generally useful. 

Vesicants, epispastics, or blistering . agents are safe 
appliances but they are distressing, and their use may be 
deferred until a physician advises them. 

I have said that the diet should be light while the pulse 
is hard and full. Afterwards when the pulse is natural, 
or if it becomes irregular or small, good broths or other 
nutrients are to be given, milk, cream, and even raw eggs 
may be administered. In general food should not be 
pressed upon a patient. 

OF TOPICAL APPLICATIONS FOR INFLAMMATION, 

I have mentioned counter irritants and I think it best 
at this time to advert to all the various topical applica- 
tions, irritating, soothing and protective, and to give such 
instructions as I can in regard to them. 



226 Mother, Nurse and Infant. 

Counter irritants are frequently applied over or near 
the seat of the disease, and often also at a remote part to 
obtain what is called revulsive action. In both instances, 
however, their action may be revulsive. If applied to the 
thorax or chest, for example in a case of pneumonia, the 
cuticle to which it is applied is almost as remote from the 
lung by the way of the circulation, as is the cuticle of the 
wrist or ankle. But practically a sinapism may be very 
useful applied at either place — possibly more useful if 
applied over the seat of the inflammation, because there 
is a sympathy between the parts — they may be used very 
beneficially in domestic medication. 

In a few succeeding pages I give some directions to 
the nurse who acts under the doctor's orders. 

Ammoniacal liniments, and other washes and em- 
brocations that are sufficiently irritating to produce red- 
ness when rubbed on the skin, should be rubbed on 
briskly so as to produce considerably increased circula- 
tion in the capillaries, &c. One of the most commonly 
used rubefacients is mustard. To make a mustard plas- 
ter, or sinapism, take one part of powdered mustard, and 
about three times the quantity of flour and mix into a 
paste with tepid water, and spread it evenly between two 
pieces of thin muslin. As hot water or vinegar weakens 
the active principle of mustard, tepid water is best, even 
if it seems cold when applied to the patient. Good sin- 
apisms are conveniently made also by doubling brown 
paper several thicknesses, wetting it and sprinkling on 
the mustard alone. 

The mustard must not be left on long enough to vesi- 
cate ; usually it should be taken off within half an hour 
(or moved,) except when applied to the soles of the feet, 
when they may commonly be left on for several hours. 



Counter Irritants. 227 

Their action must be carefully watched upon an insensible 
or delirious patient, or a little child. In mixing the plas- 
ter for children glycerine may be used, and then the plas- 
ter may remain on longer. Confine in place by a bandage. 
If the patient complain of the burning or smarting after 
the plaster is removed, dust the part with starch or fine 
flour, or dress with vaseline to exclude the air. 

You may make a cayenne pepper plaster in the same 
way that a mustard plaster is made, or you may sprinkle 
pepper upon a thin slice of pork. This makes good 
draughts for children and may be useful sometimes for 
sore throat if applied to the neck. But capsicum plasters, 
&c, can be bought at the drug store. In the country it 
is generally convenient to obtain and apply horse radish 
leaves ; these are good rubefacients. In order to produce 
immediate vesication I have known a doctor to heat an 
iron spoon until it was sufficiently hot, and then rub it 
over a small space of skin ; and a small blister may be 
quickly made by saturating a bit of cotton with hartshorn, 
putting it in a top thimble and applying it to the skin to 
remain seven or eight minutes. But the agent most com- 
monly used to produce vesication is the cantharldeal 
plaster. If you are to produce a blister with this, the 
part should first be washed and dried, shaved if there is 
any hair upon it, then if you wish the blister to rise soon 
wet the plaster and also the skin with vinegar ; apply, and 
secure the plaster in place by a bandage. Most common- 
ly it will rise in from four to eight hours, but without 
waiting for it to rise fully you may remove the plaster and 
apply a poultice which will produce the desired effect. 
Do not tear the skin in taking the plaster off. When the 
blister is well raised make a slight incision or two for the 
escape of serum, and dress with vaseline or tallow. This 



228 Mother, Nurse and Infant. 

is the usual way, but in some cases the physician may 
direct differently, perhaps may leave the blister undis- 
turbed and allow the fluid to be reabsorbed. 

Strangury and congestion of the kidneys sometimes 
follow the prolonged use of cantharides ; to prevent this, 
it is sometimes recommended that tissue paper be well 
oiled and interposed between the plaster and skin. And 
as camphor corrects the action of cantharides upon the 
bladder, it is recommended that in case of a child partic- 
ularly, a solution of camphor in ether be sprinkled upon 
the plaster. If a blister is applied to a young child, it 
should be carefully watched and not allowed to remain 
too long. In two or three hours the skin will be well 
reddened, and the plaster may be removed and a poultice 
applied. 

Tincture of iodine is sometimes applied as a counter 
irritant, but several coats and repeated applications are 
necessary to produce a blister. 

Local stimulation can be obtained from bits of canthar- 
ideal plaster kept on for an hour or two, and removed or 
changed before the point of vesication is reached. The 
same effect follows the rapid passage of a hot flat iron 
over a piece of brown paper or flannel laid upon the skin. 
It is generally best, that the flannel should be wet first ; 
and should an emergency arise when from hemorrhage or 
some other cause there is danger of immediate collapse, 
the application of heat in this way may rouse the sufferer 
and prevent immediate death. This or the actual cautery 
is sometimes used to relieve lumbago, or rheumatism. If 
you have thereby a slight burn, you may dress it in a so- 
lution of bicarbonate of soda and cover from air with 
rubber tissue- 



Cupping. 229 

If a seton is inserted in the skin, the silk should be 
moved daily and the matter well cleared out. 

Wet cups are applied to relieve congestion and to ab- 
stract blood, the skin being first scarified. 

Dry cupping is most practiced for the relief of pain 
and to draw the blood away from an inflamed organ. 
Small tumblers may be used in the absence of cupping 
glasses, if the edges are smooth. When you apply the 
cups have at hand also a lamp, a saucer of alcohol, a bit 
of sponge or a wad of lint fastened to the end of a stick. 
Have the cups perfectly dry, dip the sponge in the alco- 
hol which you will ignite from the lamp, (they being near 
the patient), and let it burn for an instant in the inverted 
glass, then withdraw and extinguish it, and rapidly place 
the cup over the intended spot. As the heated air in the 
glass condenses in cooling, the skin will be forcibly sucked 
up, and the blood drawn towards the surface. Each cup 
will remain on from three to five minutes. Do not at- 
tempt to apply them to a bony and irregular surface, and 
be very careful not to burn the patient by getting the 
edges of the glass too hot. To remove the cup press 
with the finger close to the cup so that air will be ad- 
mitted. 

Wet cupping will be attended to by the physician, 
who will provide the scarificator, and adhesive straps. 
See that plenty of soft towels are provided. 

There are two varieties of leeches used in this coun- 
try, the American and the foreign. The latter differs 
from the former in having five or six stripes down its 
back instead of three, and it will draw from five to six 
times its own weight of blood as it is larger and more 
voracious than the American variety. 

The domestic variety is sometimes preferred for chil- 



230 Mother, Nurse and Infant. 

dren, as it will draw a sufficient amount of blood usually. 
Leeches should not be applied over any large vessel, and 
preferably should be over a bony surface where pressure 
can be made to stop the blood if it continues to run. 
The leech should not be handled, it may be washed and 
dried in the folds of a towel. 

To induce them to bite, the part to which they are to 
be applied must be perfectly clean, and it may be' best to 
pick or scratch the skin so that the leech has first a taste 
of blood ; or you may put the leech in a wine glass, test 
tube, leech glass, or small bottle filled with water ; cover 
with a cord and invert over the place ; hold it close and 
slip out the paper. The leech will then probably take 
hold and the glass can be taken off, and the water ab- 
sorbed by a towel. If one is to be applied inside the 
mouth or nostril, put a thread through its tail to prevent 
its being swallowed. If such an accident should occur 
have the patient drink freely of salt and water, and induce 
vomiting. 

If the leech seems sluggish when applied stroke it gently 
with a dry towel. When full it will drop off. If you 
wish to take them off sooner, do not remove by force, but 
put a little salt on their heads. If the bleeding from the 
orifice continues too long it may be checked by a com- 
press of lint, an application of ice, or by touching with 
nitrate of silver, or carbolic acid. Leeches not used may 
be kept in a jar of water with sand in the bottom, and a 
perforated cover, or it may be covered with a linen cloth. 
The water in which they are kept should be changed 
twice a week in winter and oftener in summer. Salt will 
make a leech disgorge the blood with which it is filled, 
but if kept afterwards it is liable to be diseased, and to 
cause disease in those that are with it. 



Fomentations. 231 

By fomentations or stupes is commonly meant the 
application of flannels or towels wet with hot water or 
some medicinal decoction. If hot water only is used, 
they are a convenient means of applying warmth and 
moisture, but they require constant attention, needing to 
be changed every ten or fifteen minutes. They are chief- 
ly of use in relieving pain and inflammation, and in pro- 
moting supuration when that is desirable. 

Two pieces of flannel should be at hand each doubled 
to the desired size ; they are to be saturated with boiling 
water and wrung out dry as possible. To wring it out 
without scalding one's fingers, put it inside a towel, and 
this may be made with a hem at the end so that a stick 
can be thrust through it. Wring the flannel so dry that 
it will not make the bed or bed clothing wet. Cover with 
oiled muslin a little larger than the fomentation, and over 
that lay some dry flannel or cotton. If the stupe is put 
on hot, and frequently changed, it derives or draws blood 
towards the skin, and is often useful in relieving spasm 
and pain ; and the continued use of them prevents sup- 
puration. Medicaments are sometimes added to make 
them more irritant or sedative ; then they are not changed 
so often, but they must not be allowed to get cold. Af- 
ter the fomentations are discontinued, carefully wipe the 
parts dry to which they have been applied, and cover 
with a warm, dry flannel. 

I subjoin a few useful fomentations in which decoctions 
or medicines are used. 

1. Add one ounce muriate of ammonia and two ounces 
spirits of camphor to 1 quart of boiling water just before 
dipping the flannel into it. 

2. For a fomentation to the bowels, chest, &c, of a 



232 Mother, Nurse and Infant. 

child, take i oz. paragoric, i oz. Jamaica ginger, and 4 
ozs. hot water. 

3. Twenty drops spirits turpentine may be sprinkled 
over each stupe, but be careful about blistering the skin 
or making a sore. 

4. A decoction of chamomile flowers, hops, or conium, 
may be used for the fomentation instead of water. 

5. Twenty drops or more of laudanum may be dropped 
over each stupe. This might soothe pain without caus- 
ing stupor. 

Poultices, like stupes, are means of applying warmth 
and moisture. If applied early, it is believed they may 
prevent the formation of pus, as they bring about a reso- 
lution of the inflammation. When suppuration has com- 
menced they facilitate the passage of matter to the sur- 
face, and lessen the extent of the disease. When applied 
to an inflamed part or swelling they should extend over 
considerable surrounding surface, but for a suppurating 
wound they should be but little larger than the opening. 

Avoid putting them on very hot in a case of paralysis 
and also upon children, though they should be applied 
quite hot usually. 

To make bread poultices pour boiling water on slices 
of bread without crust, simmer a few minutes, then beat 
up the bread quickly and spread it upon a piece of mus- 
lin previously cut of the desired size, leaving about two 
inches of margin upon each side. Then put on the poul- 
tice some lard or oil or vaseline to keep it from getting 
dry and hard, and to make it less likely to stick. It 
will be well to put on it a cover of thin muslin or mos- 
quito netting, or tulle, or illusion, and then fold over like 
a broad hem the edges of both the covers. The poultice 
should be evenly spread about a quarter of inch in thick- 



Cataplasms. 233 

ness and may be carried to the patient on a small tray or 
board, and if you are changing the poultice you should 
also have a small basin to carry away the old ones. After 
applying the poultice cover with some impervious material 
(oiled muslin or rubber cloth) to keep in the heat. Such 
a poultice as this will keep warm for five or six hours, but 
it should not be allowed to become cold and hard. Milk 
should not be used in making poultices as it quickly 
sours. 

Poultices are made of various materials. Flax 
seed meal, starch, powdered slippery elm, Indian meal, 
and oat meal are used. They should all be made of such 
a consistence that they will be tenacious as possible, and 
should have at least a little oil on them to prevent their 
getting dry. 

For putrid sores some disinfectant solution may be 
used instead of water in making the poultice, such as a 
weak solution of chlorinated soda. 

Yeast poultices are used to hasten the separation of 
gangrenous sloughs. Mix six ounces of yeast with the 
same quantity of water at blood heat. Stir in fourteen 
ounces of wheat flour and let it stand near the fire until 
it rises. Apply while fermenting, or, " Take of wheat 
flour a pound, yeast half a pint, mix, and expose the 
mixture to a gentle heat until it begins to rise." 

The following are old officinal forms for poultices : 

Alum cataplasm. Take the whites of two eggs, of 
alum a drachm, shake them together so as to form a co- 
agulum. (A common mode of preparing the alum poul- 
tices is to rub the whites of two eggs briskly in a saucer 
with a lump of alum till the liquid coagulates.) The 
curd produced by coagulated milk with alum is sometimes 
used as a substitute. The alum cataplasm is sometimes 



234 Mother, Nurse and Infant. 

employed in incipient or chronic opthalmia as an astrin- 
gent application. It is placed over the eye enveloped in 
folds of cambric or soft linen. 

Cataplasm Carbonis ligni. Take a sufficient quan- 
tity of wood charcoal red hot from the fire, and having 
extinguished it by sprinkling dry sand over it, reduce it 
to very fine powder and incorporate in the simple cata- 
plasm in a tepid state. Charcoal recently prepared has 
the property of absorbing those principles upon which 
the offensive odor of putrefying, animal substance de- 
pends. In the form of poultice it is an excellent applica- 
tion to foul and gangrenous ulcers, correcting their fetor 
and improving the condition of the sore. It should be 
frequently renewed. 

Conjum Cataplasm. Take of extract of poison hem- 
lock (conium) two ounces, water a pint. Mix and add 
of bruised flax seed sufficient to produce a proper con- 
sistence. This cataplasm may be advantageously em- 
ployed as an anodyne in cancerous, scrofulous, and 
other painful ulcers, but its liability to produce narcotic 
effects in consequence of the absorption of the active 
principle of the hemlock must not be overlooked. 

Sometimes a bag is made to contain a poultice, and 
such a bag should be used if we desire to apply a large 
poultice to the chest or abdomen. One can be made for 
the breast and for the back at the same time, and two 
straps over the shoulder may unite them. A hop poultice 
is a thin bag loosely filled with hops and wrung out of 
hot water. 

Dry fomentations are sometimes employed. Thin 
bags filled with heated sand, ashes, salt, bran, or hops are 
used, to keep the heat applied to the skin ; and to warm 
the feet and quicken the circulation in the extremities, 



The Application of Cold. 235 

hot bricks, bottles filled with water, &c, are applied. 
These should be rolled in hot flannel or at least enveloped 
in something. 

OF THE APPLICATION OF COLD. 

Cold applications are sometimes used to subdue in- 
flammation in the early stages. They are not good when 
matter is forming, or during sloughing. When they are 
used they ought to be continuously applied so as to keep 
up a constant cooling effect. Sometimes either water or 
some lotion is used with the design of cooling by evapor- 
ation. If a part is wet with water, alcohol, vinegar, a 
solution of muriate of ammonia, or other fluid, and left 
uncovered, the effect will be to cool it. When you design 
to cool by evaporation do not lay on more than one thick- 
ness of muslin or lint, and this must be wet so often that 
it does not get nearly dry. But a part may be cooled by 
several folds of muslin wet in ice water, and changed for 
fresh ones before they get warm. It is important that 
they do not become warm, and hence they should be 
frequently changed ; alternate cooling and reaction is 
hurtful rather than beneficial. A steady cold stream of 
water is one means of cooling, and another device is to 
carry across a part a long strip of muslin or lamp wicking, 
having one end in a vessel of cold water higher than the 
bed, and the other leading to a basin below it. Protect 
the bed well with India rubber cloth so that both the 
patient's clothing and the bed are kept dry. 

Rubber bags are made to contain ice, and these are 
made in different shapes to be adapted to different parts 
of the body. They should not be more than half filled, 
and as soon as the ice melts the supply must be renewed. 
The ice used should be finely broken ; this may be done 



236 Mother, Nurse and Infant. 

by wrapping it in a fine cloth and pounding it. If mixed 
with one-third saw dust the ice will keep longer. A fold 
of muslin should be interposed between the ice bag and 
the skin, and they should be kept in their place by a band- 
age or some other means. An ice bladder for application 
to the head can be kept from pressing on the head by 
being folded in a napkin, which may be attached to the 
pillow by a pin. A cup shaped sponge may answer in 
the place of the ice cap to contain the ice ; this must be 
wrung out before it is saturated, so that the pillow may 
not become wet. 

Collyria are best applied to the eye at the outer angle ; 
a glass dropper or a camel's hair pencil may be used — 
this same one should be used for nothing else. Draw 
down the lower lid, and tell the patient to look up at the 
same time that the drop of eyewater is slid in. Do not 
leave moist cloths bound upon the eye as they become 
hot and may do harm. 

If you rub in liniment with your hand, wash the hand 
carefully before touching a sensitive spot, as some of the 
ingredients may cause smarting or other injury. 



CHAPTER VII. 



DUTIES OF THE NURSE IN VARIOUS CIRCUMSTANCES, CON- 
TAGION, DEATH, &C. 

The fact that certain diseases are contagious is one 
that throws some grave responsibilities upon the nurse, 
and on account of the importance of the subject, I will 
here discuss it in the light of modern science. 

Infectious diseases are supposed to be propagated by 
the agency of minute living parasites given off from the 
body of the sick and conveying the specific virus. The 
germ thereby includes this for the cause of all the zymotic 
diseases — diseases that are contagious and produced by 
some morbid principle or germs acting on the system like 
a ferment. They are claimed to be a vegetable growth of 
a fungoid nature, and the theory is that during the pro- 
cess or period of each — a period of growth like mildew — 
the victim is a sufferer from a more or less violent fever ; 
that the period varies ; in typhoid it is twenty-one days, 
in other forms of fever perhaps a shorter time, till the 
microscopic fungoid growth may be said to effloresce and 
shed its spores. Some diseases also that are not conta- 
gious are believed to be caused by organisms in the air. 
There are various kinds ; monads, bacteria, vibriones, 
&c, are among the substances found in the atmosphere 
of a large city, and elsewhere. 

A very great variety of these forms called fungoid 
growth have been seen and distinguished, and it is demon- 
strated clearly that certain forms cause certain diseases. 



238 Mother, Nurse and Infant. 

For example, cholera or choleraic symptoms have been 
induced in animals by the introduction of the cholera 
bicillus into their intestines, and almost invariably the 
dead animals showed a great abundance of the character- 
istic bacillus in the intestinal tract. The diseases which 
are now known or believed to be caused by such virus 
are very numerous, and directions for preventing a disease 
from spreading are based upon this theory ; epidemic 
and endemic diseases are generally attributed to such a 
cause. The list of germ diseases is about as extensive as 
the list of contagious diseases. 

Epidemic diseases are those that act upon numbers of 
people at the same time. Probably there is generally, 
though not always, disease organisms diffused through 
the air. 

Endemic diseases are confined to particular localities. 
Sporadic cases of disease are those occurring singly, or 
scattered considerably. 

Disinfectants are such substances as act upon the 
specific germs or minute living particles to destroy them. 
Antiseptics are such as prevent decomposition or putri- 
faction. 

Septic germs are generally destroyed when widely 
diffused in the air. It is believed that oxygen acts as a 
disinfectant, at least dry air is not favorable to their 
growth. A dry heat of 300 degrees will destroy them, 
and they are generally killed by a freezing temperature. 
Against communicable diseases the chlorine class of anti- 
septics including iodine, iodoform, bromine, and sulphur 
are the most effectual, and chlorine and sulphuric acid 
may without danger be used in the sick room to a suffi- 
cient extent to do some good. 

The most rapid and powerful of the disinfectants is the 



Contagion. 239 

solution of the bichloride of mercury (corrosive subli- 
mate). The solution most commonly used is of the 
strength of fifteen grains to the quart. It can be applied 
directly to floors, beds, walls, sinks, drains, vessels, &c. 

For clothing use a solution of common salt and sulphate 
of zinc, two ounces of the salt and four ounces of the 
sulphate to a gallon of hot water ; soak the clothes in this 
and then boil them in water with borax, or soap or soda. 

When a disease is known to be very contagious and 
dangerous, especial care is necessary to avoid contact on 
the part of patients and nurses with outsiders. All supur- 
fluous things must be taken out of the room before the 
patient is put into it, and care will be necessary contin- 
ually to make the quarantine effectual. Every article 
carried out of the sick room must be disinfected ; a set 
of dishes should be kept for the patient's exclusive use, 
washed only by the nurse ; the bedding, clothing, &c, 
must be washed by the nurses themselves, after being 
soaked in a disinfecting solution ; dressings and other 
cloths, such as old cloths used for handkerchiefs, may be 
burned ; all excrementitious and vomited matter must be 
disinfected ; the broom that is used to sweep the room 
must not be used elsewhere ; no current of air must be 
permitted to pass from the sick room to the rest of the 
house ; and it is well also to hang about the room cloths 
wet with some disinfectant solution ; hang over the door- 
way a sheet similarly disinfected ; and the nurse should 
cover her head with a close cap. 

Lest the confinement and isolation make the nurse sick 
she must take care of her own health. Two nurses should 
be employed for every such case, so that neither may be 
obliged to sleep in the same room with the patient, and 



240 Mother, Nurse and Infant. 

each should change her clothes and go out of doors for a 
time every day and take a brisk walk in the open air. 

The ventilation is of especial importance in contagious 
diseases, as no disinfection can render the air entirely 
pure. To prevent the infectious particles that are thrown 
off the skin in cases like small pox and scarlet fever, from 
polluting the air of the room, the clothes should be fre- 
quently changed, and the patient's body be washed and 
anointed with some ointment. 

Charcoal placed about the room in shallow vessels does 
some good by means of its property of absorbing gas ; 
and solutions of carbolic acid, chloride of lime, soda, and 
zinc are germicides, but the chief use of the carbolic acid 
family is where suppuration is going on, to prevent the 
spread of septic infection. It is also a means of disinfec- 
tion perhaps, if the spray is used in malarial disease. Con- 
dy's fluid and sulphate of iron are used as antiseptics, but 
these stain clothing. 

Chlorine should not be used with sulphuric acid, or 
carbolic acid. 

Either copperas or chloride of lime may be thrown dry 
into water closets. A little disinfectant should be kept 
standing in all sputa cups, urinals, and bedpans, and in 
cases of typhoid, and cholera, the stools must be carefully 
disinfected. These diseases are not only directly infec- 
tious, but the germs in the discharges may multiply and 
spread the disease. Cover the bottom of receiving vessels 
for stools with copperas or chloride of lime, and after use 
add crude hydrochloric or sulphuric acids in quantity 
equal to half the bulk of the discharge. Cover closely 
and carry from the room, and empty into a trench pre- 
pared to receive them, at a distance from the water sup- 



Disinfection. 241 

ply, and all clothing and bedding soiled by the discharges 
must be disinfected and boiled. 

After a case is ended the room must be subjected to a 
cleaning and fumigation. Everything that can be so 
treated should be either boiled or subjected to a heat of 
220 in a disinfecting oven. Rubber sheets and aprons 
may be cleaned with bichloride solution, and the floors, 
woodwork, and perhaps the walls should also be washed 
with a solution of bichloride of murcury. While the 
room is being fumigated, drawers and closets should be 
open and things not thoroughly disinfected should be 
hung up in it. A good way to fumigate the room is to 
burn sulphur in it, but you may evolve chlorine from 
common salt in the following way : Mix an equal bulk of 
common salt and black oxide of manganese in a shallow 
earthen dish, add two pints of sulphuric acid previously 
diluted with two pints of water, and stir with a stick. It 
is best in using this to have also steam in the room. 

To fumigate a room have the doors, windows, and fire- 
place closed, and paste paper carefully over the cracks. 
If sulphur is used put it in iron pans, allowing two 
pounds to every thousand cubic feet of space ; set the 
pans on brick, so that they will not burn the floor ; pour 
a little alcohol on the sulphur and ignite, then leave the 
room quickly so that you do not breathe the gas ; paste 
up the door when you go out ; keep it closed for twenty- 
four hours, then open all the windows and let the 
room air. 

Those directing the disinfection should always remem- 
ber the bleaching and corroding power of chlorine and 
sulphurous acid gas. 

When a patient has died from any infectious disease 
the body should be washed in some disinfectant solution, 



242 Mother, Nurse and Infant. 

or soap should be used containing bichloride of mercury, 
and a sheet should be wrapped around the body wet 
with the same. Saturate also a large wad of cotton with 
it and leave it under the hips. The burial should be soon 
and private in these cases. 

OF THE NURSE'S DUTIES IN CARING FOR THE DYING AND 

DEAD. 

Certain duties devolve upon the nurse in cases of 
death from any disease, and I prefer to refer to those 
duties here. 

Among the signs that indicate approaching dissolution 
are a peculiar sharpness of the features ; coldness of the 
toes, fingers and nose ; a dusky shade about the finger 
nails ; cold perspiration, restlessness, and muscular 
twitchings or stupor. When you are sure that the end is 
near it is best that the friends should be informed. 
While there is slight grounds for hope do not give up all 
efforts, but do not disturb the dying by useless ministra- 
tions. Note the exact time at which death takes place ; 
this is usually, though not always, obvious. 

There may be a rise of temperature, and the body be 
quite warm a short time after death ; this is produced by 
chemical changes, but after a short time its temperature 
corresponds with that of the room in which it is lying. 
Then the peculiar stiffening of the muscles called rigor 
mortis sets in which lasts for a time and then disappears. 
Before rigor mortis comes on prepare the body for burial 
by washing it (using a weak solution of chlorinated soda 
or carbolic acid), closing the eyes, arranging the lips 
naturally, and combing the hair. Bandage the jaws 
closely, stuff all the orifices of the body with absorbent 
cotton to prevent discharges, and bind a cloth around the 



General Rules in Nursing. 243 

hips. A clean night dress or shroud or any other clothing 
desired can be over this, then cover the face and all with 
a sheet. 

The arrangements can be put in the hands of an under- 
taker, but it is (mite likely the friends will wish you to 
superintend them. If the body is to be kept for several 
days it must be packed in ice, and after twenty-four hours 
the face has a more natural appearance. The dark dis- 
coloration of the skin observable a few hours after death 
on the neck and sides and more dependent parts, is 
caused not by mortification, but by the blood settling or 
gravitating downwards. Slight discolorations about the 
face can be made less conspicuous by dusting them with 
toilet powder. 

After the body has been taken from the house, the bed- 
ding must be sent out to be disinfected, all the appliances 
of sickness removed, the room put in order, and the win- 
dows left wide open for several hours. 

SOME GENERAL LESSONS IN NURSING. 

Rule 1. Do not get out of temper, but try to make the 
sick chamber the pleasantest and yet the quietest room 
in the house. Do not appear anxious however great your 
anxiety. 

2. Do not converse in whispers ; invalids generally 
are suspicious and will imagine all sorts of things if they 
see their friends conversing in this manner. 

3. Do not urge the invalid to eat and drink when she 
does not feel like it. 

4. Do not ask a convalescent if she would like this or 
that to eat and drink, but prepare the delicacies and pre- 
sent them in a tempting way. 



244 Mother, Nurse and Infant. 

5. Do not allow the nauseating medicine bottles to 
stand in the sight of the patient. 

6. Study all the peculiarities of your patients, and in- 
stead of opposing them by arguments or otherwise, humor 
them whenever they do not interfere with the physician's 
orders or instructions. 

7. In all cases keep everything that is used by the 
patient perfectly clean. 

8. If the patient is not allowed to drink as much as 
she desires, give her the limited quantity instead of a full 
glass. If she is allowed to drain the glass she will probably 
be satisfied. 

9. Do not allow flowers or plants to remain in the 
room over night, and always remove flowers from the sick 
chamber as soon as they become stale. 

10. In all cases the patient should have baths so often 
that the skin is kept clean, and the pores are not 
stopped up. 

11. Take care not to chill or fatigue a patient while 
bathing. A sponge bath can be given in bed, the bed be- 
ing protected by an extra draw sheet. 

12. The mouth should be often washed and the teeth 
brushed or wiped off with a soft cloth. 

13. The hair should be combed at least once daily. 
The ladies' hair is braided or twisted on top of the head 
so that she will not have to lie on a knot. 

14. Do not light a sick room at night by means of a 
jet of gas burning low. 

15. Preferably use sperm candles. 

16. Do not have the temperature of the sick room 
much above 6o°. 

17. Do not allow offensive matters to remain ; but in 
a case of emergency where these cannot be removed at 



General Rules in Nursing. 245 

once, you can wring a heavy cloth out of cold water and 
use as a cover, placing over this ordinary paper. 

18. Do not neglect during the day to attend to neces- 
saries for the night, that the rest of the patient and family 
be not disturbed. 

19. To avoid making a noise by throwing coals on the 
fire, place it in paper bags and lay them on the fire. 

20. Do not lean or sit upon the bed, if this is disagree- 
able to the patient. 

21. Always remember that nothing which contributes 
to the welfare of those who require the nurse's care, is too 
trivial to demand her attention. 

22. The following may by some be called little mat- 
ters, but attention to them will add materially to the well 
being of the sick : Refrain from constant enquiries of 
patients as to how they feel, for sick people are easily 
annoyed ; anticipate the wants of your patient if possible ; 
never tiptoe about the room ; if the patient is very sick 
have the courage to tell the friends who call that the in- 
valid cannot see friends, if able to see them their stay 
must not be prolonged ; do not allow a patient to sit up 
in bed without covering the shoulders with some light 
wrap ; support them properly with pillows, or a chair and 
pillows ; when obliged to leave the room take something 
with you which is no longer needed, and bring back 
necessary articles, thus saving annoyance to the patient 
and labor to yourself. 

23. To AVOID MISTAKES IN GIVING MEDICINE it is a 

good rule to always read the label before and after meas- 
uring the dose ; no medicine should ever be given in the 
dark ; tie a ribbon on bottles that contain remedies for 
external use ; shake a bottle before opening it ; do not 
leave a bottle uncorked ; generally keep medicines in a 



246 Mother, Nurse and Infant. 

dark closet which is cool as possible ; have every medi- 
cine that is dangerous taken internally labeled "poison"; 
keep them under lock and key. 

24. The nurse should know the ordinary doses of 
medicines and the symptoms of overdosing. Every un- 
usual and inordinate action of a drug may be a good 
reason for omitting a dose or two till the physician is 
seen and new directions are given, otherwise be always 
regular and prompt in the administration of medicines. 

25. But in general the nurse can best display her 
knowledge and exercise her skill by faithfully carrying out 
the instructions she has received from the physician. If 
the directions are not what she would expect, it may be 
an exceptional case ; the doctor and not the nurse is the 
judge as to what is exceptional ; she must obey his orders. 
Do not receive orders from the physician in silence, and 
when he is gone refuse to obey them. The nurse should 
never hide anything from the doctor, even if she has done 
wrong ; it is a serious thing to think that life should be 
risked in order to conceal wrong doing. Never be afraid 
of troubling the doctor ; he will always be glad to hear - 
anything that will help in the diagnosis or treatment of 
the case. The nurse has much to do with an art whose 
end is the saving of human life ; any neglect to act openly 
and intelligently becomes a crime. 

26. Remember that kindness and tenderness as well 
as faithfulness are needful to successful nursing. 

BEDSORES. 

Every precaution should be taken by the nurse to 
avoid bedsores on her patient. These appear most fre- 
quently upon the hips, but may develop elsewhere in 
parts subjected to pressure. To harden the parts they 



Bedsores. 247 

must be frequently washed with soap and water and 
thoroughly dried. A draw sheet should be placed under 
the patient that can be changed as often as it becomes 
wet and damp. Be careful to keep the sheet free from 
wrinjdes and inequalities, and the patient's clothes must 
be kept smooth under her. Occasionally rub on the skin 
oil or vaseline, and then dust on some fine powder such 
as oxide of zinc, fine starch, or toilet powder. 

Plasters that are entirely unirritating may be applied 
either before or after there is an evident sore, and if 
change of position is not possible, it may be necessary to 
obtain air cushions or a water bed. 

An air mattrass or air cushions may be put on any bed, 
but a water bed must be put in a trough or wooden 
frame made of just the right size. The water in a bed of 
this kind should be of a temperature of 70 and renewed 
every two weeks. To prevent a water bed from sticking 
to the boards some old cloths must be interposed. 

Reddening and roughening of the skin, and pain on 
pressure indicate an approaching bedsore before there is 
an abrasion of the skin. Those washes that cause smart- 
ing must be discontinued, and sulphate of zinc ointment, 
and unirritating plasters used. 

If a part is dead and likely to slough off, apply char- 
coal or yeast or chlorinated poultices until the gangrenous 
parts can be removed. After the separation of the slough 
you can apply lint smeared over with carbolated cosmo- 
line or whatever application the surgeon or doctor may 
direct. The sore must be washed and applications re- 
newed each day, and at each time it may be covered with 
a piece of oiled silk or muslin, or rubber tissue confined 
in place by adhesive straps. 



248 Mother, Nurse and Infant. 

BATHS. 

The sponge bath or washing can be done partly un- 
der the bed clothes, and but a small part of the body 
need to be exposed at a time. Do not bathe immediately 
after a meal. 

Always have a bath of the temperature directed by the 
doctor. The following terms are used to indicate differ- 
ent temperatures : 



BATH. 


WATER. 




VAPOR. 


AIR. 


Cold, 


32 to 65° 


Fahr. 






Cool, 

Temperate, 

Tepid, 

Warm, 

Hot, 


65 " 75 
75 ' 85 
85 92 
92 '* 98 
98 " 112 




90 to IOO° 
IOO " 115 
115 " 140 


96 to 106 
106 <l 120 
120 " 180 



To put a feeble patient in a bath wrap her in a sheet 
and lower her gently down in it. When she is taken out 
wrap her in a warm dry sheet and over this fold a blan- 
ket. After a few minutes' rest and a little wiping with a 
soft dry towel the clothes may be put on. 

Do not give a cold bath when the patient feels chilly, 
when there is perspiration, or there is inflammation or 
congestion of an internal organ. 

The temperature of the body may be lessened by means 
of the wet pack in cold water, or by means of a sheet 
wrung out of cold water wrapped around the patient, and 
changed every ten or fifteen minutes, or by applying 
towels from the neck downwards, wrung out of cold 
water. 

For the wet pack the sheet may be wrung out of either 
hot or cold water. Spread a comforter and two blankets 
on the bed and over these a sheet wrung out of the water. 
Remove all the patient's clothing, lay her in the middle 
of the sheet, then draw over one side after another of the 
blankets and comforter, wrapping her from the neck to 



Sponging and Bathing. 249 

ankles ; apply something to the feet to keep them warm, 
give plenty of drink, and put a wet compress on the fore- 
head. If this is intended to induce perspiration or re- 
pose, the patient may remain in the pack two or three 
hours. 

A blanket bath is used as a means of sweating. A 
blanket is wrung out of hot water and wrapped around 
the patient. She is to be packed in three or four dry 
blankets and allowed to rest quietly for thirty minutes. 
Then the surface of the body must be well rubbed with 
warm towels, and the patient made comfortable in bed. 

Cold or tepid sponging is sometimes directed when 
there is a fever. Commence at the head and sponge 
downwards, then wrap in a blanket and leave her undis- 
turbed for an hour or more. 

The effect of the hot bath if long continued is to in- 
duce languor and weakness. Watch by the patient while 
she is in the water, and take her out if there is any sign 
of fainting. Do not give a hot bath during a menstrual 
period. 

A hot foot bath is one of the best means of revulsion 
to relieve the head. Let the water come nearly to the 
knees, cover both the patient and tub with a blanket, 
keep the feet in the hot water for about twenty minutes. 

If a hot air bath or a vapor bath is given, some 
device should be used to keep the blankets from pressing 
upon the patient. Two half hoops may be tied together 
so that they answer the purpose. By the same means 
steam may be diffused around her, if hot bricks wrapped 
in wet flannel and put on dishes are placed in the bed 
beside her, or steam can be conducted from a boiling 
teakettle under the blankets. Or place the patient in a 
large cane seated chair, and surround both completely 

*i6 



250 Mother, Nurse and Infant. 

with blankets, letting them extend to the floor and be 
secured about the patient's neck. Under the chair, place 
a basin of hot water with an alcohol lamp beneath it ; 
bring the water to boiling, and the patient will soon be in 
a perspiration which may be carried to any extent. 

For a bran bath, boil two pounds of bran in a gallon 
of water and add to the bath. 

For a salt bath, add one pound rock salt to every four 
gallons of water. 

For a sulphur bath, add twenty grains sulphuret of 
potassium to a gallon of water. Used for skin diseases 
and rheumatism. 

In cases where there is a high fever, especially in chil- 
dren, the warm water bath is given to reduce the tem- 
perature. If a child that has a temperature of 104 is 
immersed in water heated only to 98 for fifteen or twen- 
ty minutes, it will part with some of its heat. 

BATHING OF INFANTS. 

The bath for very young infants should be quite warm 
— about 97 . Some nurses ascertain if it is an agreeable 
warmth by dipping an elbow in the water. The tempera- 
ture may from week to week be lowered gradually to 85° 
or 8o°. Two baths a day may be given. The evening 
bath should be warmer than the morning. A brisk, gen- 
tle rubbing after the bath is beneficial. If a child gets 
blue and shivers the bath is too cold. The warm bath 
will often serve to put a restless and feverish child to 
sleep. 

To bathe an infant support its head on your hand and 
arm, dip the baby into the bath ; then rub the whole sur T 
face of the skin rapidly with a soft sponge or piece of 
flannel soaped ; next again immerse the body in the 



Surgical Nursing. 251 

water, then quickly and thoroughly dry with a fine warm 
towel. 

Before giving a bath have every thing likely to be need- 
ed at hand, and the room warm. 

CHANGING CLOTHING. 

Before raising up a patient to put on a chemise or 
night dress, pull up the soiled one towards the neck, and 
as soon as the head and shoulders are raised, the soiled 
garment can be slipped off over the head and a clean 
one put on ; then pull this down smoothly under the back 
before laying the patient down. 

If two garments are worn one can be slipped inside the 
other, and they can be slipped on as one. 



CHAPTER VI. 

SURGICAL NURSING. 

Before I dwell particularly upon surgical cases and 
wounds of all kinds, I will refer to some general duties of 
the nurse who attends during a surgical operation. 

Generally the patient to be operated on should have a 
bath the previous night, and perhaps an enema on the 
morning of the operation ; if the operation is on the 
female genital organs a warm douche should be given. 

Prepare the room by having it well cleaned and aired 
and of a temperature of about 85 °. Such things as are 
likely to be needed ; for example, vaseline, carbolic acid, 
basins, sponges, towels, scissors, needles, pins, ice, hot 
and cold water, should be provided. If you have to make 
bandages, an old cotton sheet is good material from which 
to tear the strips. To join the strips lay two ends flat on 



252 Mother, Nurse and Infant. 

each other overlapping for an inch, and baste together all 
four sides. A roller bandage may be from two to twelve 
yards long ; it must be rolled as tightly as possible ; the 
selvage and all loose threads must be trimmed off. 

The proper cleaning and preparing of sponges is im- 
portant. If one has been used it should be well washed 
and left in a solution of sal soda, and then kept for several 
days in a five per cent, solution of carbolic acid. New 
sponges should be prepared with twice as much care. 

In a case where there is to be an operation upon the 
female genitals, a T bandage may be required ; this should 
be put on before the ether is given, at least the part above 
the hips, the other part may be left free till after the 
operation, to be then brought between the thighs and 
attached to the other in front. 

Only a little light food should be taken for three or 
four hours before etherization. Prepare the patient for 
going to the room by having her hair combed and braid- 
ed, artificial teeth must be taken out, and all tight bands 
loosened. Arrange the clothing so that it will be pro- 
tected, and so that it can be changed afterwards easily. 
See that she passes the urine the last thing before taking 
her place for the operation. 

Have a bed ready that is properly made and protected, 
to which she can be moved when the doctors allow it, 
and where she can be kept quiet. If there is nausea and 
vomiting, the effects of the ether, you may quiet it by 
letting her sip a little hot water or by putting a hot, dry 
cloth on her neck and chest. During the operation you 
had simply to wait on the surgeon, now the patient will 
be principally in your care. 

You will receive instruction from the surgeon in regard 



Traumatic Erysipelas. 253 

to things needing peculiar watchfulness and every point 
must be carefully noted. 

As the wound may need to be watched during the first 
twenty-four hours for hemorrhage, it must be so arranged 
that it can be looked at without waking the patient. 

The danger to which surgical cases are liable are, 1. 
Shock ; 2. Hemorrhage; 3. Erysipelas; 4. Pyemia; 5. 
Tetanus. If there is traumatic erysipelas the edges 
of the wound are red and swollen, the secretion of 
pus ceases, and by the next day the skin around the 
wound becomes of a peculiar red color. There will be 
fever, headache, nausea, and a coated tongue. 

Erysipelas can be generated by inattention to sanitary 
laws. It is infectious and spread by fomites, and the 
virus of erysipelas may give rise to puerperal fever. It is 
not proper for a nurse that has had the care of a case of 
erysipelas, to soon be the nurse of a lying-in woman, even 
if she is careful about using disinfectants on her hands 
and changing her clothes. 

Certain influences augment the susceptibility of the 
body to the agency of the poison. Among the influences 
are intemperance, low spirits, anxiety, insufficient nourish- 
ment, and foul air. There should be great care in regard 
to ventilation, and clearing and cleaning the room where 
it has been present. 

The disease cannot be cut short by active remedies, 
but may be made to terminate favorably by the use of the 
perchloride of iron, &c. (F. 177.) 

Tetanus (lockjaw) may follow slight wounds. At 
first the muscles of the jaw are rigid, but the rigidity or 
spasms may extend all over the body. It may result from 
exposure of the wound to cold, and some cases of tetanus 
in infants have been attributed to the funis, in instances 



254 Mother, Nurse and Infant. 

where as much as three or four inches were left attached 
to the unibilicus. In a case of tetanus the patient should 
lie in a darkened room, and noise should also be excluded. 

Incised wounds, made in the flesh by sharp cutting 
instruments, of course may be-trivial cuts,*or deep incis- 
ions, and may sometimes be treated by the nurse, either 
because they are slight injuries or because a surgeon can- 
not immediately be obtained. 

If there is not much bleeding there will not be very 
much to do. It is well to have a little carbolic acid in 
the water with which it is washed. The bleeding will 
soon cease if only small vessels are divided. If there is 
any extraneous matter on the surface of the wound it 
must be removed. Then put the surface of the lips of 
the cuts together, and take measures to keep them in this 
state till they have become firmly healed. If sutures are 
necessary take one or more stitches. The most common 
method of keeping the surface of divided parts in contact 
is by strips of adhesive plaster. Apply them after having 
put the wounded parts in a position favorable for bring- 
ing the edges of the wound together, then while one holds 
the lips of the wound evenly together secure them in this 
position by strips of adhesive plaster applied across the 
line of the wound. Leave a little interspace between each 
two strips of plaster. It is not best to bind it up so that 
there is no passage or exit for blood. But slight wounds 
may become serious if some poison or virus gets into it ; 
you may need to put on lint or a compress over the strips 
of plaster and then a roller or bandage. 

But some incised wounds instead of being immediately 
dressed and bound up, demand that immediate attention 
should be paid to the hemorrhage. We may usually know 
whether the bleeding is arterial, venous or capillary. If 



Bleeding Wounds. 255 

the wound is open, blood from an artery will spurt out in 
jets and is of a bright red color. Unless the artery is 
very small a surgeon will be needed, but you may be re- 
quired to act very promptly to suppress for a time a dan- 
gerous flow of blood. If a large artery is cut or punctured 
the hemorrhage may be fatal in a short time. The appli- 
cation of heat or cold, and the elevation of the part in- 
jured, may suffice in slight cases, but in these severe cases 
other means are necessary. 

First endeavor to arrest the rapid flow of blood by 
pressure upon the wounded artery with your thumb. 
Then if the wound is in a limb let some one tie a hand- 
kerchief loosely around the limb, and if you know the 
course of the artery have the knot directly over it and 
between the heart and the wound. Then put a stick in 
under and twist the handkerchief so that it is tight enough 
to compress the artery. The hemorrhage can . thus be 
checked until the surgeon arrives. If the wound is over 
a bone in the head or body, the bleeding may probably 
be checked by binding on a hard compress where the 
artery is cut, thus making direct pressure upon it. A 
ligature upon a limb ought not to remain very tight more 
than an hour. 

If the hemorrhage is from a leg below the knee it may 
be checked by putting a firm roll of cotton in the flexed 
jpint, and pressing the lower part of the leg against the 
thigh ; this will compress the artery. 

Contused wounds are not often attended with serious 
hemorrhage. If there is in the bruised part only slight 
subcutamous laceration, nature may soon repair the in- 
jury. But if there is considerable contusion indicated by 
the ecchymosis where small blood vessels have been lac- 
erated and the blood extravasated into celular tissue, 



256 Mother, Nurse and Infant. 

causing the dark discolored spots and other evidences of 
severe injury, there will be subsequent inflammation, per- 
haps suppuration, demanding treatment. A proper mode 
of dressing at first is to bind on a compress saturated 
with a four per cent, solution of carbolic acid, and for the 
fever and inflammation one drop doses of ext. veratrum 
may be given. 

But in all cases where wounds are severe the services 
of a physician will be required. 

A punctured wound signifies one made with a sharp 
pointed instrument, the external opening being small 
compared to its depth. It is a good rule in these cases 
to leave a free vent for any discharge that may be set up. 
The danger in these cases is from serious injury to the 
deep seated parts, and from suppuration which may bur- 
row and extend still deeper if there is not free exit for 
the pus. 

One mode of treating poisoned punctural wounds 
(serpent bites, &c), which of course are peculiarly dan- 
gerous, is by applying cups over the wound. 

Any wound that suppurates much or sloughs causes a 
cavity to be filled up, and the process by which the 
wounds and sores heal is called granulation, and cicitri- 
zation. The wound is gradually filled up to the surround- 
ing level by new tissue appearing in the form of small 
red granules bathed in pus. Healthy granulations on an 
exposed or flat surface rise nearly even with the sur- 
rounding skin, and often a little higher, but when they 
are much higher, and take on a growing action, they are 
what is called proud flesh. Their growth may be checked 
by the application of active astringents ; nitrate of silver 
or burnt alum may be used, or adhesive straps may be 
applied. The skin with which it is covered when healed 



Suppurating Wounds. 257 

is formed from the surrounding skin, and the process 
which is called CICITRIZATION does not go on well except 
when the granulations are nearly level with the adjacent 
skin. The centre of a sore has power to form new skin 
when there is a particle of live skin there, and for this 
reason skin is sometimes grafted in. 

A patient suffering from a suppurating wound becomes 
enfeebled from the discharge of pus, and should have his 
strength kept up by nourishing food. A surgeon will al- 
ways endeavor to prevent the retention and decomposi- 
tion of discharges, and to protect from external contami- 
nation. He will direct the time and means of dressing 
the wounds, but the nurse must remember that decom- 
posed animal matter acts as a virulent poison introduced 
into the system as it may be through any abrasion of the 
skin. All instruments used about a wound must be thor- 
oughly cleansed before being put away. Dressings which 
have been next the wound should be burned ; those 
which are to be washed should be disinfected. Avoid 
soiling your own hands with discharges ; protect with a 
bit of plaster every place where there is any cut, or scratch, 
or sore. If you fear that any virus has got in where 
there is any sore, or where the skin is broken, touch it 
with carbolic acid. 

FRACTURES AND DISLOCATIONS. 

One of the signs of a fracture is crepitus, the sound 
made by the rubbing of the ends of broken bones together. 
This sound cannot always be obtained, even when the 
bone can be moved so that the ends rub each other, and 
as such motion causes considerable pain the nurse should 
not seek for it, except as she harkens when the limb is 
accidentally or necessarily moved. The separation and 



258 Mother, Nurse and Infant. 

inequalities of the ends of the fracture (when the bones 
are superficial), the change in the form of the limb, and 
the shortening of it, are circumstances communicating in- 
formation in very many cases, and the diagnosis is made 
pretty certain if there is unnatural mobility of the limb. 
In other cases there is loss of motion or immobility, 
swelling and pain in the injured part, &c, but it will pos- 
sibly require the services of the skillful surgeon to detect 
the existence and character of a fracture ; and generally 
the coaptation or setting of the bone, can be deferred 
until he arrives. The nurse can do something in the 
meantime — can have the patient and fractured limb put 
in as easy a position as possible ; perhaps have something 
ready for bandages and splints. A splint may be made 
of anything that will hold the bone securely in place ; it 
should be longer than the bone that is broken. Sole 
leather is sometimes used ; cut the required size, softened 
in hot water, moulded to fit the part and left on until dry, 
when it will be of the desired shape. Plaster of Paris 
bandages are sometimes used. These are prepared by 
rubbing into the ordinary muslin rollers dry plaster. 
They are then rolled. When they are applied, soft flan- 
nel bandages are first put on the broken limb, then the 
one containing plaster is (after being dipped in water, and 
some of the water squeezed out), applied over the flannel. 
It takes ten or twelve hours for this to set and become 
hard, and the broken limb must be kept still during the 
time. Dust the part over with toilet powder before the 
bandage is applied. The success of the surgeon depends 
very much on the good constant care of the nurse. If it 
is necessary to move the limb keep up some extension on 
it and do not twist it. Be very careful that the directions 
of the surgeon are carried out, and it will probably be 



Dislocations. 259 

necessary to keep up extension all the time, otherwise the 
deformity may return and the limb be shortened. 

Dislocations are not so easily reduced as fractures, 
but after the setting and reduction of a dislocated joint 
the action of the muscles tends to keep it in place. 
There is always some laceration of the ligaments and suf- 
ficient injury to the soft parts to excite a little inflamma- 
tion, but the pain is relieved as soon as the bones are 
replaced. 

In general recent dislocations are easily reduced, but 
when the head of a bone has been out of its place for 
several days the reduction becomes exceedingly difficult, 
and as a rule the difficulty of reduction arising from the 
muscles is proportioned to the length of time that has 
elapsed from the period of the accident. For this reason 
a person who has a little general knowledge on the sub- 
ject of dislocations, should sometimes make an attempt 
at reduction immediately after the accident. 

The signs of dislocations are pain, incapacity of motion 
in the limb, change in the length of the limb and in the 
direction of its axis. Sometimes the dislocated limb is 
nearly incapable of any motion, and sometimes the de- 
struction of the means of union, allows the limb to obey 
any extraneous influence. 

The replacing of the dislocation would require very 
little effort or force were it not for the resistance of the 
muscles and tendons attached to them. In reducing a 
luxated bone the main point is to apply force until the 
head of the bone dislocated can be slipped into its place, 
which is generally when it is nearly to a level with its 
socket. This is easily effected immediately after the ac- 
cident, because at that time the resistance of the muscles 
is not great ; it may be best to attempt it, but there should 
be no delay in sending for a surgeon. 



260 Mother, Nurse and Infant. 

I recommend that an attempt be made to set a dislo- 
cated thumb or finger by making extension on the 
lower member and at the same time pressing the head of 
the bone towards its natural situation. If the reduction 
is effected, the thumb or finger should be rolled with tape 
and surrounded and supported with pasteboard ; and the 
hand and forearm put in a sling. A surgeon may be 
necessary even in a case of dislocated thumb or finger, 
but bones out of joint are so much more easily set at first, 
that it is best to attempt to set them then, and the same 
may be said of some larger bones. 

For instance, if there is a dislocation of the elbow, 
the patient being settled, let one man take hold of his arm 
near the shoulder, to make counter extension while an- 
other makes extension at the wrist. You yourself being 
seated grasp the elbow with your two hands by applying 
your fingers to the anterior part and your thumbs to the 
posterior, press on the projecting point of bone down- 
wards and forwards. You will generally be successful, 
but I do not advise five minutes' delay in sending for a 
surgeon. I only advise that an effort be made imme- 
diately. 

After thus reducing a dislocation of the forearm back- 
wards at the elbow, apply a bandage in the form of a fig- 
ure of eight ; apply some lotion or liniment, and keep the 
arm in a sling. At the end of seven or eight days when 
the inflammation has subsided, the articulation can be 
gently moved, and the motion may be increased every day. 

The figure of eight bandage is a roller applied alter- 
nately above and below a joint, the roll being carried 
obliquely over a central point. 

The art of putting on a roller bandage is an important 
one for a nurse to acquire, and I may here give a few 



Applying a Bandage. 261 

general principles though no exact directions can be 
given. In applying a bandage care must be taken that it 
is put on tight enough to fulfil the object in view, without 
running any risk of stopping the circulation. A bandage 
must lie smoothly, without wrinkles, and making an even 
pressure. For bandaging an arm or leg a roller from two 
to three inches wide may be used ; a few turns may first 
be given on the hand or foot, and after this every circle 
is to be applied so as to ascend up the limb in a gradual 
spiral form and cover about one-third of the turn of the 
roller immediately below it. To accommodate it to the 
shape of the limb reverses are made. The bandage is 
doubled back by placing a finger on the lower edge to 
hold it firmly, and turning the bandage downward oyer 
itself, at such an angle as properly shapes its direction, 
and these turns can be made as often as is necessary. 



PAI^T VI. 

REMEDIES AND REGIMEN. 



CHAPTER I. 

HINTS IN REGARD TO THE TREATMENT OF COMMON 

DISEASES. 

It is my design in a subsequent part of this work, under 
the head of emergencies, to refer to those exceptional 
cases in which there is" peculiar danger, where some 
prompt action, something done immediately may either 
save life or save from protracted disease. In such cases 
the well instructed nurse may often do something without 
assuming undue responsibility. 

But I now intend to give such instruction in regard to 
the treatment of minor ailments and complaints which are 
liable to arise in every family daily, as will enable the 
mother or nurse to often relieve present distress, and 
prevent future sickness and suffering. But I hope it is 
fully understood that while I give such instruction as is 
founded upon many years of study, and experience, and 
observation, I do not expect that any one can become a 
doctor by the perusal of this small treatise, or that the 
student of this book will ever set herself in opposition to 
those who have devoted years to the study of the healing 
art. With the understanding, then, that the mother is to 
prescribe medicine only in such cases as mothers usually 

262 



Domestic Medication. 267, 

do prescribe, I will now give some directions that will 
enable the nurse or mother to act with promptness and 
assurance and efficiency. 

Some medicine should be kept in every house, and I 
suggest the following as a good list : Aconite, veratrum, 
paregoric, aromatic ammonia, spirits camphor, essence 
peppermint, spirits nitre, syrup ipecac, witch hazel, adhe- 
sive plaster, chlorate of potash, gum arabic, compound 
licorice powder, carbolic acid, and the sanguinaria powder. 

The last, which is the medicine that I always use in 
diphtheria, may be prepared according to the following 
formula : Take of pulverized blood root \ ounce, Ferri 
sulphas Exsiccata J ounce. Triturate together. Dose, 1 
grain put on the tongue dry every four hours. The 
medicine should be kept dry and is best kept in a phial 
corked. 

All the medicines should be labeled with the name and 
ordinary dose. 

A small quantity of medicine will suffice to keep in the 
house. I suggest the following amounts and labels : \ oz. 
tinct. aconite. Dose, ■£$ °f a drop (or less) every hour. 
Poison. \ oz. veratrum viride. Dose, \ drop every two 
hours. 1 oz. paregoric. Dose, 1 drop to a teaspoonful. 1 
oz. aromatic ammonia. Dose, 20 drops diluted in water. 
1 oz. ess. peppermint. Dose, 10 drops. 1 oz. spirits 
camphor. Dose, 1 to 5 drops. 1 oz. syrup ipecac. Dose, 
5 drops to a teaspoonful. 1 oz. spirits nitre. Dose, \ 
teaspoonful in water. \ oz. fid. ex. witch hazel. Dose, 
1 drop every hour. \ oz. chlorate potash. \ lb. com- 
pound licorice powder. Dose, 1 teaspoonful. 1 oz. gum 
Arabic. \ yd. adhesive plaster. 1 oz. carbolic acid and 
glycerine. Poison. 1 oz. sanguinaria powder. Dose, 1 
grain. 



264 Mother, Nurse and Infant. 

I will now give my treatment of diphtheria which is 
mostly by the use of the Sanguinaria powder, as this very 
well illustrates the benefit of having some mild safe medi- 
cine in the house, and using it early in the disease. 
Nearly thirty years ago I was so well satisfied of the effi- 
cacy of this medicine, that I advised all the families with 
which I was acquainted and where I was their physician, 
to keep the powder in the house and use it whenever any 
of them had sore throat ; very many of them did so, and 
it has happened that so far as I know, there has not been 
a fatal case of diphtheria among them. 

I advise that it be given in all cases of sore throat, for 
although it is not so important a remedy in all these cases, 
it will very generally be useful in a greater or less degree, 
and as the sore throat is usually the first thing complained 
of in diphtheria, its early application is thereby assured. 

A very small dose will suffice, but there is no objection 
to taking two or three grains for a dose every 4 hours, 
except the disagreeable taste. I advise that it be taken 
alone, and not covered up, as I believe that it acts locally 
perhaps directly upon the organism or germ that is the 
cause of the disease. I have not, however, relied exclu- 
sively upon the one medicine, but have always directed 
that they should give about a teaspoonful of the saturated 
solution of chlorate of potash every hour, and that they 
keep kerosene applied on the outside of the throat or 
neck. Give plenty of milk and other nourishing diet, and 
but little other medicine is usually required. 

The sanguinaria (bloodroot) powder is properly 
given in other cases besides diphtheria. A small dose 
given three times a day is not only a good worm medicine, 
but will prevent the subsequent developement and growth 
and multiplication of worms for some time. It is also a 



Aconite, Veratrum. 265 

cure for a cough that is dependent on an irritated state of 
the fauces. 

Three grains taken after each meal is a good remedy in 
chlorosis or suppression of the menses. In these cases it 
.can be taken covered up in wafers or in rice paper, there- 
by avoiding the bitter taste. 

Aconite should be kept in the house, and very small 
doses given in cases where there is a little feverishness, 
and no marked symptoms of disease. It is useful when 
there is an ordinary cold, and may be given two drops of 
the tincture in' half a glass of water, one teaspoonful every 
hour. These small doses may be given to a little child, 
and yet they have some effect upon older persons. 

Ordinary colds, however, require more efficient treat- 
ment, and I often direct the following : A teaspoonful 
ginger, a teaspoonful cream of tartar, and three large tea- 
spoonfuls of sugar in a small glass of water, to be drank 
as one draught after being stirred. Heat the feet and 
keep them warm especially at night. The combination of 
ginger, cream of tartar, &c., opens all the secretions so 
that the lungs, liver, bowels, skin, and kidneys act in a 
natural manner, and there is immediate benefit. 

Veratrum has already been mentioned as a remedy in 
inflammation. If good extract or tincture is used it can 
always be relied on to reduce the force and frequency of 
the pulse. It is frequently applicable because in most of 
our diseases the force and frequency of the pulse is in- 
creased. The pulse should be counted when it is first 
given, and counted occasionally afterwards, and when the 
pulse becomes less frequent the dose must be diminished 
or omitted. If an overdose is given it is commonly vom- 
ited, otherwise it might be dangerous. Ordinarily half a 
drop every two hours of the fluid extract is sufficient, but 



266 Mother, Nurse and Infant. 

for adults two drops may sometimes be given and repeated 
in an hour. We have so many maladies that are inflam- 
matory, where the pulse is full and hard, that the indica- 
tions for its use are frequent. Even in the commence- 
ment of fevers, when the pulse is full and quick — where 
it was formerly the practice of physicians to bleed, vera- 
trum should be given till it has a decided effect upon the 
pulse. In intermittent fever the effect of this sedative 
upon it, given at the commencement of the fever or hot 
stage, is as salutary as is the effect of quinine given dur- 
ing the intermission. 

Moderate doses are not liable to do harm except to 
those who have become quite weak and low. A conve- 
nient way of administering it is to prepare twenty drops 
of the extract in twenty teaspoonfuls of water, and the 
dose can be easily regulated. 

Croup may generally be cured if veratrum is given 
early and in efficient doses. It is of no avail to adminis- 
ter it at an advanced stage when there is apncea ; the 
pulse becoming feeble and intermitting, the lips blue, the 
skin losing its heat ; and when drowsiness, coma or other 
fatal symptoms are coming on. When cough, hoarseness, 
catarrh, and loss of voice are noticed in a young child, it 
should be narrowly watched and protected against all cir- 
cumstances likely to aggravate inflammation ; it should 
be kept in the house, and a warm, moist air should be 
kept in the room (about 65 °), its diet should be milk or 
farinaceous food ; the functions of the bowels and skin 
should be attended to ; some aconite should be given ; if 
there is a slight, ringing cough, place the patient in a 
warm bath for ten minutes, then confine it to bed ; keep 
the air of the room moist by the evaporation of boiling 
water ; give castor oil or other physic, and small doses of 



Treatment of Croup. 267 

syrup ipecac, and spirits nitre. If the respiration becomes 
sonorous and difficult, the voice hoarse and gruff, the 
cough croupy and brassy as it is called, you have the 
characteristic symptoms of croup. But the peculiar 
breathing, making a sort of crowing sound with each in- 
spiration, will always distinguish it, and there will always 
be some fever attending it. Croup sometimes commences 
with sore throat, and I believe that the sanguinaria pow- 
der will usually be efficacious in its cure ; but prompt 
doses of veratrum are still more effectual. At the early 
stages you may give two drops of the extract, and the 
dose may be repeated in half an hour, and perhaps re- 
peated afterwards. If there is not evident improvement 
an ounce of syrup of ipecac or a teaspoonful of sugar and 
alum pulverized together, may be given if necessary to 
make the child vomit. 

In the meantime hot fomentations should have been 
applied to the throat. A sponge the size of a large fist, 
dipped in water as hot as can be borne, should be squeezed 
half dry and applied under the child's chin so as to cover 
the larynx, and the temperature maintained by resoaking 
it every two or three minutes. 

Baths may be used during the second stage of the 
croup ; if the child has a temperature of 104 , a warm 
bath ought to be administered, and the child immersed in 
it up to its chin for fifteen or twenty minutes. 

After the breathing is relieved, still give small doses of 
syrup of ipecac, or alum, or veratrum, sufficient to keep 
up nausea for a time. After there is a decided ameliora- 
tion of the symptoms, give the following : To a teacupful 
of ginger tea add a teaspoonful of aromatic ammonia, and 
a teaspoonful syrup of ipecac, and give a teaspoonful 
every hour. 



268 Mother, Nurse and Infant. 

Veratrum is the medicine upon which you must rely 
in croupy cases ; this disease requires vigorous treatment, 
but vigorous measures in the start will generally save the 
life of the patient. 

Paregoric is a useful medicine for pain, diarrhoea, 
cough and restlessness, and may generally be given ad- 
vantageously when two of these symptoms are present. 
Opium has some beneficial effect in inflammation, and 
very generally paregoric can be given where there is 
febrile excitement. I would never give it when the child 
is only cross and irritable, as a bad habit may thereby be 
engendered. There is always danger of giving an over- 
dose of any opiate ; and although an adult may sometimes 
take as much as two ounces of paregoric when he is suf- 
fering severe pain, I do not advise that it be given to 
children often in doses that exceed five drops. 

Diarrhcea may be treated in the following manner : 
To four ounces of ginger tea add one teaspoonful pare- 
goric, one teaspoonful aromatic ammonia, one teaspoon- 
ful ess. peppermint, one half teaspoonful spirits camphor, 
and two ounces of mucilage of gum arabic, and shake the 
whole together. This is good medicine for all forms of 
summer complaint, diarrhcea, dysentery, or cholera mor- 
bus. One-half teaspoonful of this is a dose, but it can be 
given efficiently in a larger or smaller dose. It acts by 
correcting the disordered state of the stomach, and it is 
upon this usually that these diseases depend. 

If the diarrhcea continues for a day or two, some mild 
astringent may be given ; perhaps three drops every two 
hours of the extract of witch hazel. The diet is impor- 
tant, and it is well in these cases to have some wheat 
flour boiled. (F. 47.) The flour grated from it and 



Diarrhoea, Dysentery. 269 

sifted, and made into a gruel, may be profitably used with 
milk. 

A thin solution of c.im Arabic with milk affords both 
food and drink, and is one of the most useful, and safe, 
and efficient remedies. 

Such medicines as F. 74, 77, 79, 80, may be given in 
almost every case with benefit. The alkalies neutralize 
the acids in the stomach, and the aromatics have a grate- 
ful action. If the pain continues, a warm bath may be 
given. Should the gums be swollen, they should be cut 
down to the teeth. 

But there are many cases of diarrhoea where my pre- 
scription would be the following : Give no kind of food 
save that of the milk of the mother, and that only once in 
four hours. Should the thirst require more fluid to satis- 
fy it, give from time to time a teaspoonful of cold water ; 
put flannel on its body, and woolen stockings on its legs ; 
rub the abdomen three or four times a day with the bare 
warm hand ; do not ever wake the child when asleep ; 
when awake give it five drops paregoric every two hours. 

In the preliminary stage of cholera infantum, be- 
sides giving the diarrhoea mixture with ar. ammonia, I 
would enjoin absolute rest in the recumbent position, 
with warmth to the surface and extremities ; perhaps total 
abstention from mother's and cow's milk, and would order 
either condensed milk or arrow root prepared with water. 
I would also make counter irritation over the abdomen 
by poultices and sinapisms. 

Dysentery when first coming on is attended with more 
fever than diarrhoea is. It will be distinguished by the 
character of the pain and the discharges. The patient is 
tormented by a sensation as if there was some excrement 
to be dislodged ; he goes often to the night chair, and 



270 Mother, Nurse and Infant. 

strains to get rid of the irritation ; he discharges but little, 
and what is voided is either a jelly like or bloody mucus ; 
perhaps mixed with films and membranous shreds. The 
pulse is hard and frequent, the skin hot, the face flushed, 
and the patient complains of headache and thirst. 

You may give some veratrum at first ; one-half drop of 
the extract every two hours for one day ; and to allay the 
thirst, give cold water in which some wheat flour has been 
stirred. 

My principal remedies if the diarrhoea mixture does 
not cure, is to give the sour drops (elixir vitriol), and 
either large or small doses of ipecac. I also use injec- 
tions of starch and laudanum, and rectal suppositories. 
(F. 155, 160.) 

You may find much benefit from some domestic reme- 
dies. Give either occasional doses of strong table tea, or 
spoonful doses of vinegar and table salt, or freshly pre- 
pared melted mutton suet. 

Aromatic spirit of ammonia is useful in hysteria, 
flatulent colic and nervous debility. It is not a powerful 
medicine to overcome disease, but it is a medicine that 
ought to be at hand to relieve many little ailments that 
are liable to occur, when much medicine cannot be given. 
I advise those that are suffering from sick headache to 
take 30 or 40 drops of it as a stimulant antacid. It may 
be well also to take a teaspoonful of paregoric, and to lie 
down till sleep gives relief. Fainting fits or fainting 
may demand a remedy, and 15 drops ar. spts. ammonia 
may give the desired relief, if the sufferer lie down and 
a little cold water be sprinkled in her face also. 

This medicine is a grateful antacid in cases of sour 
stomach, and it will usually give some relief in the flatu- 
lence and distress of dyspepsia. 



Domestic M edicines 271 

It may often be used as a slight stimulent, but as it is 
an alkaline remedy it should not be given conjoined with 
acids. 

Essence peppermint and spirits camphor are often 
used in ailments similar to those in which I use aromatic 
ammonia, and this may be given in combination with 
them. Some persons have a decided preference for 
essence cinnamon, or wintergreen, and these may be sub- 
stituted for peppermint ; aromatics also, such as sweet 
flag, will have a similar effect. 

Spirits nitre is often a grateful stimulant to the stom- 
ach, but it is also used in febrile affections, and inflam- 
matory complaints. Four parts of spirits nitre to one of 
ar. ammonia is diuretic, diaphoretic, and is well suited to 
certain states of febrile disease. 

When given to promote the action of the kidneys, a 

half teaspoonful or more may be given every two hours in 

a spoonful of water. Scanty and high colored urine, 

i especially when it is acrid and burning, is an indication 

for its use. 

Syrup of ipecac is used as an expectorant and emetic 
in colds and coughs. If given to a child, one teaspoonful 
is an emetic dose, to be repeated every fifteen minutes 
till it operates. If given to loosen a cough, five or six 
drops repeated every half hour will suffice ; but it may be 
given in much larger doses. It is often given in combi- 
nation. (F. 137, 139.) 

Witch Hazel. Pond's Extract Hamamelis is kept by 
many people in the house, and as it is usually accom- 
panied with directions, I shall refer to it very briefly. 
The ordinary fluid extract is perhaps five times as strong 
as Pond's extract, and when used may be diluted accord- 
ingly. It is astringent, and a medicine of that kind is 



272 Mother, Nurse and Infant. 

often useful both internally and externally. A few drops 
taken each day may prevent bleeding, when there is a 
tendency to hemorrhage, although ergot would be a more 
efficient remedy if given for immediate effect. 

Chlorate of potash is very generally given in diph- 
theria, and is generally safe ; no harm can come from the 
advice to keep it constantly in the house ; it is not very 
soluble, and the saturated solution is not too strong for 
use. It is a good way to put a half teaspoonful of it in a 
glass, and keep a little water on it all the time, and give 
ten or twelve teaspoonful doses of the solution a day for 
any kind of sore throat or mouth. 

Compound licorice powder (F. 108) is a mild laxative, 
and may be given to a young child in half teaspoonful 
doses. In larger doses it will serve well for older persons 
for physic. While I think it well to keep this in the house 
and to occasionally administer it, some other sort of 
cathartic may at times properly be preferred. A great 
variety of this sort of medicine is attainable, no one kind # 
is always the best ; this powder is however a good laxa- 
tive, in doses of a teaspoonful repeated in eight hours if 
necessary. 

Gum Arabic is not often kept in the house as a medi- 
cine, but I think it eminently proper to keep it ; scarcely 
any other medicine is so safe and harmless either in large 
or small doses, and few are more decidedly useful than 
this in some cases. Made into an emulsion and taken 
either alone or in combination with other medicine, or 
used as food, it is good in every variety of bowel com- 
plaint. A teaspoonful of the mucilage stirred into a cup of 
cold water and drank by the patient, may serve as medi- 
cine and drink and sustenance when he can take no other 
food. It may properly be added to expectorant and 



Carbolic Acid. 273 

diuretic medicines ; hut the beneficial effects are most 
obvious when it is administered for inflammatory affec- 
tions of the gastric and intestinal mucous membrane. 
Slippery elm and flaxseed tea have a similar effect, but 
are not so decidedly beneficial. 

Carbolic acid nine parts and glycerine one part 
may be kept mixed together ; not because the glycerine 
assists or modifies the action of the carbolic acid, but be- 
cause it renders the acid soluble in the water, so that the 
solution may be of any strength desired. Carbolic acid 
is not much used internally ; it is so powerful that it 
ought to be regarded as a poison ; its effect is good, how- 
ever, if given in small doses very much diluted. It is be- 
lieved to be destructive to disease germs, and may very 
properly be given in bad cases of diarrhoea and dysentery. 
Two drops of the acid in a glass of water is a weak so- 
lution, and may be given without harm ; a half teaspoon- 
ful every two hours. 

There is not space in this work to describe particularly 
the various cases in which it may be used externally. A 
solution one part in 100 of water, may be applied advan- 
tageously to any inflamed part or to any cutaneous 
eruption, or may be used as a wash or gargle in any 
sore mouth or sore throat. To cure sores or eruptions, 
however, it is often necessary to apply it much stronger. 
I apply a 1 to 5 solution to the sores once or twice, and 
to burns a solution 1 to 30 for a few days. 

I will give more particular directions for its use in 
hemorrhoids or piles. Apply the acid and glycerine 
(9 to 1) to the piles by dropping 3 drops upon a bit of 
tissue paper and pressing it against the tumors, and into 
the anus. Repeat this each day for three days, then use 
a mild ointment or suppositories. (F. 206.) 



274 Mother, Nurse and Infant. 

A few doses of the compound licorice powder will be 
useful for piles if the bowels are not regular. 

I have already given some specific directions in regard 
to some diseases in very young children ; what further 
instructions I give will be of a general character. 

HOME REMEDIES AND APPLIANCES FOR SICK CHILDREN. 

Dentition predisposes to sickness, if it does not cause 
it, and it may call into activity latent tendencies to dis- 
ease. It may cause such symptoms as the following : 
redness, heat, and tenderness of the gums ; an increase 
of saliva ; starting as if in fright ; restlessness, or inter- 
rupted sleep ; eruptions on the head or body ; derange- 
ment of the digestive organs, and sometimes convulsions. 
During the period of dentition, be especially careful that 
the child has its food and sleep regularly, and that it is 
restricted to suitable quantities of food at a time. Keep 
the head cool and the feet warm ; wash the child daily in 
cold water, and allow it to be much in the open air. If a 
child is worrisome and irritable it will be necessary to cut 
the gums. Lance them at the elevated points, cutting 
them down to the teeth. At the same time, aconite can 
be given, and perhaps a warm bath ; and if there is con- 
siderable fever give ordinary doses of veratrum. These 
remedies are so generally useful where there is fever, that 
I will venture to recommend them when either thrush, 
measles, German measles, mumps, scarlet fever, 
chicken pox, or whooping cough is coming on or sus- 
pected. Each of these diseases have a natural course 
which they must run before they terminate, and it is best, 
as in diphtheria, not to give medicines powerful enough 
to interfere with the natural course of the disease. Do 
not give physic. (F. 121, 122.) 



Op thai. mia, Cons i n-\ i ion. 275 

So in opthalmia it is better to have nothing but a little- 
salt in the water than it is to use harsh things to bathe 
the child's eyes. Do not rub the eyes ; let a small stream 
of tepid water trickle onto them, and wipe the discharges 
away with a soft rag. Burn the rag, wash your own 
hands, and keep them away from your own eyes, on ac- 
count of the danger from contagion. (F. 210, 211.) 

Constipation cannot be treated in all cases without 
giving some aperient medicine. (F. 108, 109.) Oat meal 
gruel as a diet may be helpful ; and fresh vegetables — 
cabbages, turnips, onions, ripe fruit ; oatmeal porridge 
with molasses, and brown bread may be taken freely. 
Infants may be partly fed on corn starch, and older chil- 
dren may have cracked wheat (F. 35), or peas, beans, 
squashes, and other fresh vegetables and fruits in their 
season. A good draught of water on rising and retiring 
is advisable ; and a teaspoonful of soda and molasses 
mixed together and taken daily for a week may cure a 
costive habit. A suppository of castile soap may induce 
a movement in a child, or it may be best to give an in- 
jection of tepid water, or soap and water. 

For chafings bathe the parts well in tepid water, dry 
with soft cloths, and apply by means of a soft sponge, 
F. 212. 

The following diseases are inflammatory, and demand 
at first mild treatment with aconite, veratrum, and warm 
baths : 

In tonsititis (quinsy), use the blood root powder and 
bicarbonate of soda. The patient can apply the bicar- 
bonate of soda to the inflamed tonsil with his finger, or it 
can be blown into his throat through a quill, or through a 
hollow roll of stiff paper that contains a few grains. For 
the chronic form of tonsilar enlargement use F. 213. 



276 - Mother, Nurse and Infant. 

Coryza or snivels is an inflammatory affection of the 
mucous lining of the nose, attended with an abnormal 
secretion. Sometimes the child can only breathe through 
its mouth ; in such cases you may draw the breast milk, 
and feed the child by means of a spoon. Give aconite, 
and as a local application the inside of the nose may be 
often smeared with vaseline, or cold cream, or carbolated 
cosmoline. 

Bronchitis, pneumonia, pleurisy, and other inflammatory 
diseases, may not show their distinctive character in their 
incipient stage, but there will be at first sufficient fever to 
indicate the need of aconite, veratrum, and perhaps the 
warm bath. Accessary means may be used, such as the 
following : the patient should be placed in a warm room 
(about 65 °) and have only light bed clothing ; if the child 
is taken out of bed he must have on a warm wrapper, or 
be otherwise well covered ; he should not lie flat in bed, 
but he should be somewhat propped up with pillows ; 
and it may be best to keep on a continuous poultice to 
the chest in front and back. The patient should be kept 
very quiet, have mucilaginous drinks and farinaceous 
diet ; and the air of the room should be moistened by 
steam or the evaporation of water ; and the ventilation of 
the apartment must not be neglected. They must have 
frequent sips of cold water to allay thirst, besides marsh- 
mallow, slippery elm, or flaxseed tea, and revulsives must 
be used as well as poultices and fomentations. 

By the aid of a clinical thermometer many diseases 
may be distinguished even in the incipient stage. 

If a person without any premonitory symptoms is seized 
with a chill, followed by rapid breathing, a dull pain in 
the chest, cough, high fever, and comparatively slow pulse ; 
if the thermometer indicates a temperature of 104° or 



Ague, Phthisis. 277 

105 °, and the pulse does not beat over 1 10 a minute, the 
case is one of acute pneumoma. Sometimes the pulse 
is below 90 ; if it exceed 120 it is almost certain to be 
fatal. 

Ague. Chills recurring regularly for a few days indi- 
cate the intermittent nature of a disease. But during the 
first chill if the thermometer is applied, we may know that 
a case is one of fever and ague, if while the skin is yet 
cold the thermometer rises to 105 , and later to 107°, and 
during the stage of sweating the instrument shows a de- 
cline of 2 every fifteen minutes till it has reached 98-2°. 
This rapid rise and decline is due only to malaria, and 
quinine is indicated. (F. 182.) 

Tubercular Phthisis, if a patient has been losing 
flesh of late and been troubled with a short,, dry cough, 
take his temperature at about six p. m. for a few evenings. 
If the thermometer records 99 to ioo°, and no other 
cause exists for this regular nightly increase of tempera- 
ture, the case can be put down as one of incipient con- 
sumption, especially if tuberculosis has been in the fam- 
ily. Endeavor to improve the general nutrition by at- 
tention to the quantity and quality of the food (as gen- 
erous diet as can be taken without disturbing the stomach 
or increasing the feverish symptoms); by enjoining a resi- 
dence in a healthy climate ; by exercise in the open air ; 
by warm clothing ; by daily tepid sponging, with friction 
of the skin ; and by codliver oil or petroleum emulsion 
with hypophosphites. An animal diet is generally neces- 
sary. If digestion fails and there is acidity of the stom- 
ach, give pepsin. (F. 72.) Add a teaspoonful of sweet- 
ened lime water to a tumbler full of milk, and if this 
agrees with his stomach, he can take that amount four 
times a day. 



278 Mother, Nurse and Infant. 

In typhoid fever the patient may complain of lassi- 
tude, headache, pain in the back, etc., for several days 
before he is feverish. Then his temperature is 99 , and 
it may be one degree higher each night, until on the sixth 
and seventh evening it is 104° ; it being each morning 
one degree less than at night. Even if there is no diar- 
rhoea, tympanitis, or eruption, we may by observing the 
temperature, feel sure that we have a case of typhoid 
fever. If it is a moderate case the temperature will be 
104° at night, and 103^° in the morning, till the four- 
teenth day, when it may decline one degree in the morn- 
ing, and half a degree or one degree in the evening. 
After that it may decline regularly till on the 21st day it 
may be 98^°. Relapse or chest difficulty may modify this 
regular decline, and the nurse must carefully note and 
report to the physician the temperature each morning 
and night. 

In typhus fever the temperature reaches its height, 
104 or 105°, within thirty-six hours. It continues at 
that height, with morning remissions of one-half degree, 
till the eleventh or thirteenth day, when it rapidly falls to 
the normal ; a sweat or a long sleep ushering in the favor- 
able termination. 

Scarlet Fever. If a child is suddenly taken ill with 
a chill, vomitings, very rapid pulse, and the thermometer 
records 105 or more, very early in the disease, it denotes 
scarlet fever ; and from this sign alone, even without any 
sore throat or eruption, a diagnosis may be made. This 
disease may very frequently go on well without any dan- 
ger till the eruption subsides, but danger arises from ex- 
posure of the child to cold any time during the subsequent 
four weeks. 

Hysteria. There may be pain perhaps in the bowels, 



Emergencies. 279 

abdominal tenderness, and vomiting ; or there may be 
symptoms of inflammation in some other part ; if the 
thermometer does not register more than 98. I it is proba- 
bly hysteria. Assafcetida, valerian, and such remedies will 
probably cure. 

Apoplexy. In this disease the thermometer soon after 
the attack shows a temperature of only 97°, and lower 
still if there should be a second effusion to still more 
compress the brain. On the contrary, in a fully devel- 
oped case of sunstroke, the thermometer will not record 
less than 107 . 

It would be a good thing if every nurse and every 
mother kept a clinical thermometer. 



CHAPTER VII. 

EMERGENCIES, ACCIDENTS, SUDDEN SICKNESS. 

The diseases last named were there mentioned because 
their distinctive character could be determined by the 
thermometer. They are, however, examples of the kind 
of cases that I design now to speak of particularly ; where 
there is apparent cause for alarm, and where there is ap- 
parent necessity that something should be done imme- 
diately. 

These cases demand the services of a physician, and 
my design is only to instruct you what to do before the 
doctor arrives ; or rather I should say, the instructions 
that I give are not intended to supercede medical advice, 
though some cases may be of a kind in which little or 
nothing can be done. These emergencies are of every 



280 Mother, Nurse and Infant. 

variety, and I shall bring the different kinds before you 
as fully as I can. Ordinarily it is not at first apparent 
what the real malady is. 

We will suppose that during the heat of summer a man 
drops down unconscious. At first no one knows whether 
it is apoplexy or sunstroke. Do not get excited and do 
things that are rash ; if you do not know what ought to 
be done, do nothing ; if you are not excited you may at 
least use what knowledge you have acquired. 

Send a message to the doctor, giving a description as 
far as you can of the case, so that he may come prepared 
to treat it. Secure plenty of fresh air and room, and get 
rid of those who are around, who cannot be useful ; if 
respiration is suspended, and there is immediate danger, 
something may be done at once ; at least to know if the 
man has merely fainted. Have him laid in a horizontal 
position ; you may soon have him carried to the nearest 
house. For this something should be provided on which 
he can lie horizontally ; instruct the bearers to avoid un- 
necessary jolting ; have a bed ready to put him on ; if 
the case is supposed to be fainting give aromatic ammonia 
or a little stimulant of some kind ; do not raise the head, 
but keep it low as the feet. If it is a severe case of sun- 
stroke, the skin is hot and the pulse weak and fluttering ; 
there may be convulsions, but probably there will be no 
movement ; remove the clothing with as little disturbance 
as possible ; do not cut anything that can be ripped ; 
throw cold water on the head and chest, or put the pa- 
tient in a cold bath of about 70 at first, and gradually 
reduce the degree of cold ; give a cup of good table tea ; 
do not give alcoholic stimulants without medical advice. 
If consciousness returns and the temperature again rises, 
repeat the cold applications to the head, neck, and chest ; 



Apoplexy, Poisons. 281 

give ice water or ice tea ; it may be best to rub the head 
and body an hour longer, and to give stimulant enemata. 

Apoplexy can be distinguished from syncope by the 
pulse, which beats perhaps with unnatural force ; the face 
instead of being pale is generally flushed, and turgid, and 
the respiration goes on though it may be labored and 
stertorous. The condition of the sensorial functions is 
much the same as it is in narcotic poisoning, or when a 
man is dead drunk. The nurse should make all neces- 
sary enquiries so that she can furnish the physician with 
a full history of the case to help him in his diagnosis. In 
apoplexy the pulse is rather slow though full, and the 
pupils of the eyes, one or both, dilated. There may be 
paralysis of one side. 

Loosen the clothes, elevate the head and chest, apply 
cold water to the head, and heat to the extremities, and 
perhaps sinapisms also. Giving physic may be deferred 
until the doctor arrives ; and in general you may pursue 
a similar course whether the case is one of concussion 
of the brain, or compression or narcotic poisoning ; 
cold may be applied to the head by means of pounded 
ice in a bladder ; keep the head cool and the feet warm. 

Many of this class of cases require still very careful 
nursing after the dangerous symptoms are relieved. The 
skin should be kept healthy by daily friction and bathing. 
The bowels must not be permitted to become costive ; 
the diet should be light, the food well chewed, the mind 
kept cheerful and free from excitement. 

POISONS. 

In cases of poisoning no time is to be lost in adminis- 
tering relief, and it is important that the nurse should be 
familiar with all the usual antidotes. 



282 Mother, Nurse and Infant. 

Most commonly in a case of poisoning, speedy free 
vomiting should be induced by those articles that are at 
hand, and that are quick and prompt in their effects. 

Even if the poison has been taken hypodermically, 
emetics may be given ; these will do no harm : Sulphate 
of zinc (white vitriol), is very prompt in its action, and 
may be used when it can be procured (F. 134) ; and if 
vomiting be present, we may aid it by giving warm water, 
or perhaps pulv. ipecac, or some other vegetable emetic. 

But either common salt or mustard is nearly always at 
hand and may be given. Stir up a tablespoonful of salt 
or a teaspoonful of mustard in a cup of warm water, and 
give immediately, and repeat until a pint is swallowed ; 
do not stop to stir them very much, but give as quickly 
as possible. You may tickle the throat with a finger or a 
feather to induce immediate vomiting. Do not give tar- 
tar emetic ; do not give fluids so as to distend the stom- 
ach too much ; some bland fluid may be given with or 
immediately after giving mustard and salt ; either milk, 
lime water, white of egg, flour and water, gruel, drinks 
sweetened with honey or sugar. Oil should not be given 
unless ordered. 

Before naming the antidotes for particular poisons I 
wish to instruct the nurse to not only note the symptoms, 
but also to examine every article of a suspicious nature, 
(such as phials, boxes, or papers containing powders), and 
preserve them. Preserve also all vomited matter and 
everything that may afford a clue to the poison for after 
inspection, if the nature of the poison is likely to be a 
subject of after inquiry. 

In regard to the symptoms it may be well to know that 
Prussic acid, cyanide of potassium, strong ammonia, pure 
carbonic acid gas, or pure carbonic oxide may kill al- 



Symptoms of Poisoning. 283 

most at once, as indeed almost every poison may if taken 
in a very large dose ; strong acids, alkalies, aconite, an- 
timony, arsenic, tobacco, or lobelia may cause speedy 
collapse. 

Belladonna, hyoscyamus, strammonium, canabis indica, 
alcohol or camphor, may cause delirium. 

Nux vomica, strychnine, antimony, or arsenic may cause 
tetanus or tonic contraction of the muscles. 

Antimony, arsenic, carbonic oxide, aconite, strong acids 
or alkalies may cause convulsions. 

Gelsemium, conium, aconite, arsenic, or lead may cause 

PARALYSIS. 

Belladonna, atropine, hyoscyamus, or strammonium 
causes dry skin ; and opium, aconite, antimony, alcohol 
or lobelia causes moist skin. The skin is almost always 
moist in collapse. 

Belladonna, atropine, hyoscyamus, stammonium, aco- 
nite, alcohol, chloroform or conium may cause dilated 
pupils. 

Opium or chloral may cause contracted pupils, es- 
pecially during sleep. 

Prussic acid, laudanum, alcohol, carbolic acid, acetic 
acid, ammonia, chloroform, creosote, iodine, phosphorus, 
camphor, or nitro benzole can often be smelled in the 

BREATH. 

Belladonna, atropine, hyoscyamus, strammonium or 
opium cause the mouth and tongue to be dry. p 

Arsenic, ammonia, cantharides, jaborondi or mercury 
cause SALIVATION. 

Arsenic, antimony, corrosive sublimate, cantharides, 
digitalis, colchicum or colycinth causes vomiting and 
purging. 



284 Mother, Nurse and Infant. 

Lead, colycinth, copper, or arsenic causes colic. Arse- 
nic, antimony and lead cause croup. 

ACIDS OF AN IRRITATING CHARACTER. 

These include acetic, citric, muriatic, nitric, ox- 
alic, sulphuric, and arsenious acids. Their irritating 
and corrosive character depend upon their strength and 
concentration, or the amount taken, some or all of them 
being salutary in small diluted doses. Their injurious 
effects are severe the moment they are swallowed, as they 
excoriate the throat and gullet at the time of swallowing. 
But antidotes will lessen their power on the stomach and 
bowels if given soon, and if given with the emetic will 
render the vomited matter less irritating. Their corro- 
sive character causes severe pain, which may be followed 
by symptoms of shock. 

Alkalies are the antidotes. Give some one that is at 
hand, either calcined magnesia, a solution of soda or soap, 
lime water or whiting. At the same time the emetics and 
alkalies are taken, give demulcents, such as milk, muci- 
lage, gruel, flaxseed tea, etc. Of course the inflammation 
consequent on the poison must be treated. 

Carbolic acid might be included among those above 
named ; the same treatment would be proper, except that 
strong alkalies are ineffectual as antidotes. Besides emet- 
ics give milk, demulcent drinks, and carbonate of magne- 
sia, with a little paregoric in water. Secure rest and 
warmth to the body, use counter irritants externally. 

Arsenious acid is included in the above list. The 
antidote for this is hydrated peroxide of iron, recently 
prepared, and given in large doses. It is prepared by the 
addition of liq. ammonia to muriated tinct. of iron, or 
liq. ferri sulph., which yields the hydrated peroxide of iron 



Poisons and Antidotes. 285 

as a dense precipitate ; and this should be given in table- 
spoonful doses every five minutes until the symptoms are 
relieved. The nurse and attendant's duty, however, is to 
give emetics and demulcents freely. 

Alkalies are like the acids, irritating ; if strong they 
excoriate the fauces and esophagus. Caustic potash, 
lye, soda and hartshorn are examples. In these cases 
give acids such as vinegar and lemon juice as antidotes, 
and oils also to unite with the alkali and render it less 
irritating. Demulcent drinks must be given with the 
emetics, and acids must be continued afterwards. 

For lunar caustic (nitrate of silver) give two tea- 
spoonfuls of salt in a pint of water, also the white of egg 
with other demulcents. 

Corrosive sublimate. For this poison the antidote 
is white of egg and milk, or a mixture of wheat flour and 
water and soap, which may be given with emetics, or 
after them ; before if no emetic is at hand. The attend- 
ant nervous symptoms may be alleviated with paregoric. 

Tartar emetic of itself produces vomiting, but this 
may be kept up by giving mucilage and such astringent 
infusions as common tea, &c. 

Copper. The sulphate or acetate of copper might act 
as an emetic, but small quantities remaining in the stom- 
ach might act as irritant poisons. Give large doses of 
simple syrup as warm as can be swallowed ; give also the 
whites of eggs and large quantities of milk ; and as an 
antidote the hydrated peroxide of iron. 

For bismuth, iodine, or copperas taken in an over- 
dose, give the same emetics and demulcents as for copper. 

Zinc and Tin. The sulphate of zinc and the salts of 
tin when not vomited entirely, produce severe irritating 



286 Mother, Nurse and Infant. 

effects on the stomach. Besides milk and albumen give 
carbonate of soda in solution. 

Colycinth, croton oil, and savine oil may produce 
like the above, vomiting, diarrhoea, and also constriction 
of the throat. Give copious doses of barley water, etc.; 
give opium and perhaps stimulants. These cases and all 
the rest of the above may be benefitted by taking freely 
of gum Arabic mucilage, and may demand treatment for 
inflammation. 

Cantharides may produce severe pain in the bowels, 
bloody evacuations, strangury, burning thirst and fever. 
Give emolient drinks with enemata, to which some lauda- 
num may be added, and also camphor ; oil must not be 
given in cases of poisoning by cantharides or phosphorus. 

Toadstools, agaric, aconite, belladonna, conium, 
colchicum, hellebore, and alcohol, are acro-narcotics 
which may cause severe irritation of the throat and stom- 
ach, and such symptoms as burning heat of the esophagus 
and stomach, thirst, violent nausea, purging, dryness and 
constriction of the mouth and throat ; and be followed by 
such symptoms as are produced by narcotic poisons : 
vertigo, headache, perversion of vision, sense of suffoca- 
tion, disposition to sleep, numbness or paralysis of the 
limbs, prostration of the strength, cold extremities, feeble 
pulse, and stupor. 

Strammonium, camphor, chloral, digitalis, bit- 
ter-sweet and hyoscyamus may be called narcotic 
poisons. Give prompt emetics, demulcents, witch hazel, 
active purgatives, strong coffee ; keep the patient roused, 
use electro-magnetism, cold douche, and employ friction. 

For phosphorus, which a child sometimes obtains 
from the ends of matches, give emetics, and administer 
big doses of magnesia in water and mucilage. There are 



Poisons \\n ANTIDOTES. 287 

a few other poisons which might be classed as irritant, 
such as nitrate potash (salt petre) which need the same 
class of remedies as those already named. For nitre give 
also stimulants freely. 

Opium and belladonna are antidotes to each other, and 
if a person has taken an overdose of one, the other should 
be given if it is at hand. Evacuate the stomach perhaps 
by tickling the fauces ; give, also strong coffee, active 
stimulants, witch hazel ; employ friction, perhaps electro 
magnetism, and keep the patient moving. Morphine of 
course demands the same. 

For nux vomica and strychnine, besides giving an 
emetic give aromatic spirits ammonia, and also chloroform 
internally in ^ drachm doses diluted. Give tannin and 
also animal charcoal, milk and spirits camphor in large 
doses. 

Carbonate and acetate of lead sometimes act as 
poisons. Give sulphate of zinc as an emetic, and epsom 
or glauber salts as a cathartic. A mixture of syrup and 
persulphuret of iron may be given as an antidote to any 
mineral poison. 

Hydrocyanic or Prussic acid, laurel water, and 
cyanide of potash cause immediately extreme prostra- 
tion, nausea, giddiness, pale countenance, slow breathing, 
and paralysis. Dash cold water on the face to produce a 
shock, taking care not to soak the clothes of the patient ; 
we may produce a more decided effect if we alternate 
cold and hot effusions. Have the patient inhale steam 
containing liquor ammonia or hartshorn ; give internally 
aromatic ammonia and chloroform ; use friction, espec- 
ially along the spine and feet ; artificial respiration may 
be necessary. Give chlorine water of the strength of two 
drachms to the ounce. 



288 Mother, Nurse and Infant. 

Animal Poisons. For bites of serpents apply a 
ligature above the wounded part ; use carbolic acid or 
any active caustic ; apply cupping glass (or mouth, when 
there is no sore in the mouth.) Bisulphite of soda in 
large doses is said to be an antidote. Give stimulants in 
large quantities. 

Mad Dog Bites. A person having been bitten by a 
mad dog, or one suspected of rabies, the wound must 
first be made to bleed, then washed, and finally cauterized. 
Enlarge the wound so that the blood may flow out freely ; 
press out still more blood, and you may safely suck out 
some if you do not have any sore on your mouth or lips. 
After tying a bandage above the wound it must be washed 
until cauterization can be effected. This can be made 
either with Vienna paste, butter of antimony, chloride of 
zinc, or a red hot iron. If the dog can be secured and 
shut up it is better than that he should be immediately 
killed. If the dog does not prove to be mad, the person 
bitten should know the fact, as this may prevent the 
alarming fears that of themselves sometimes prove disas- 
trous. The bitten person should have his mind diverted 
as much as possible. 

Carbonic Acid Gas. A person having been poisoned 
by inhaling choke damp or the fumes of burning char- 
coal, loosen the clothing, dash cold water on the head 
and face, give plenty of fresh air, stimulants, and inhala- 
tions of ammonia. Employ artificial respiration if neces- 
sary. If the body is cold employ hot applications. 

OTHER EMERGENCIES, PERSONS ASPHYXIATED FROM 
DROWNING, HANGING, &C. 

When a person is asphyxiated treat him instantly. Give 
all the fresh air possible ; remove all light clothing from 



Emergencies. 289 

the chest and neck and face ; try to restore respiration 
first ; clear the throat by placing the patient on the face 
with one arm under the forehead ; the tongue falls for- 
ward and leaves the windpipe free ; then wipe and cleanse 
the mouth. 

To excite respiration turn the patient on his side 
and apply some stimulating agent (as camphor or am- 
monia) near the nostrils, and dash cold water, or hot and 
cold water alternately on the chest, which may have been 
previously rubbed briskly. (The effort to promote 
warmth and circulation by rubbing should be kept up 
continuously as far as possible.) Should there be no 
respiration immediately you can use 

Marshall Hall's method to imitate respiration. 
" Turn the patient again on his face, raising and supporting 
the chest well on a folded coat or other article of dress ; 
make gentle pressure on the back, after which turn him 
over on his side ; then again on his face, and again press 
a little ; repeat these motions at the rate of fifteen a min- 
ute. During the operation let one person attend to the 
movements of the head and the arm placed under it." If 
there is respiration and consequent life, dry the hands, in 
cases of drowning ; and as soon as you can, strip the 
body and gradually reclothe or cover it ; but if the breath- 
ing is not satisfactory, after continuing these same efforts 
to restore respiration for about fifteen minutes, you 
may use 

Sylvester's Method. " Place the patient on the back 
on a flat surface, inclined a little upward from the feet ; 
raise and support the shoulders and head on a cushion or 
a folded article of dress ; draw forward the patient's 
tongue, and keep it projecting beyond the lips, by having 
a band or string around the tongue and chin, or by rais- 



290 Mother, Nurse and Infant. 

ing the lower jaw so that the teeth retain it ; standing at 
the patient's head, grasp the arms near the elbows and 
draw them steadily upward above the head, and keep 
them stretched upwards for two seconds ; then turn down 
the patient's arms and press them gently and firmly 
against the chest for two seconds ; repeat the movement 
alternately about fifteen times every minute until a spon- 
taneous effort to inspire is perceived ; then proceed to 

INDUCE CIRCULATION AND WARMTH." Rub the limbs 

upward with energy, and continue the friction under the 
blanket and over the dry clothing ; promote the warmth 
of the body by applying flannels, bottles of hot water to 
the pit of the stomach, the armpit, the thighs, and the sole 
of the feet ; then if the power of swallowing has returned, 
stimulants and coffee should be administered. 

A stroke of lightning may cause immediate death 
by its effects on the nervous system. Sometimes it pro- 
duces unconsciousness without being fatal. In attempting 
resusitation employ artificial respiration, and if there are 
any signs of life treat as directed for shock. If there are 
burns complicating the case, of course the burns must be 
treated. When there is shock the patient lies in an 
apoplectic state, the surface pale ; there is faintness, trem- 
bling, cold perspiration, low temperature, feeble pulse, 
and probably nausea and vomiting. Keep the patient's 
head low, give aromatic ammonia, and apply heat to the 
extremities and to the stomach. Strong beef tea should 
be given, and hot tea and coffee. 

There are but few exigencies that generally occasion 
more alarm than convulsions. Fits may come on without 
premonitory symptoms ; there is sudden loss of conscious- 
ness, accompanied by irregular and powerful contractions 
of the muscles. All the voluntary muscles may be affect- 



Anesthetics. 291 

ed, or there may be only spasm of the features, or of one 
side, or of a single limb. During a general paroxysm the 
countenance is distorted, and the face pallid or livid ; 
generally there is stertorous breathing, and as the attack 
subsides a disposition to sleep. It is seldom fatal in 
adults, unless caused by brain or kidney disease. 

Do not attempt too much treatment, but you may put 
the patient in such a condition as to help his recovery. 
His dress is to be loosened, and all clothing about his 
neck removed ; place him where he can breathe pure and 
cool air, and you may prevent his falling out of bed ; if 
the face is flushed, cold may be applied to the head and 
warmth and sinapisms to the extremities. If occurring in 
a young child you may give a warm bath, or a warm hip 
bath. If there is ability to swallow, give bromide of po- 
tassium, either alone or simultaneously with the adminis- 
tration of chloroform and ether. 

GIVING ANESTHETICS. 

If you give chloroform you may pour a few drops on a 
handkerchief and hold it an inch from the patient's nose 
and lips. Ether and chloroform together may be poured, 
a teaspoonful at a time on a little cotton inside a cone of 
paper made large enough to fit over the mouth and nose, 
the air being nearly shut out. The head of the patient 
must be kept low while he is under the influence of it. 
Observe the pulse while giving it ; a feeble pulse is a sign 
of danger, and if the pulse is growing weak, or the face is 
growing livid or pale, stop giving the chloroform ; if the 
symptoms continue, and there is no natural respiration, 
draw the tongue forward so that it will not obstruct the 
trachea ; have plenty of fresh air ; apply friction by rub- 
bing the limbs, and if necessary artificial respiration. 



292 Mother, Nurse and Infant. 

clothes on fire. 

Accidents from fire are very likely to cause a panic, 
but possibly you may by effort so cultivate coolness and 
presence of mind, as to act wisely and deliberately even 
then, even if your own clothes are on fire. If you are 
able to think at all, the question will be if there is water 
within reach that can be used to extinguish it imme- 
diately ; if there is not, how can it be smothered ? Possi- 
bly the burning portion can be enveloped in that part of 
the dress that is not burned ; or a rug may be within 
reach, or some woolen thing that may be used to stifle it, 
without pressing it against the person's flesh. But very 
probably the best that the person can do is to lie down on 
the floor and roll on the carpet. If you see another wo- 
man on fire, do not scream or run away ; grasp her clothes 
all together, if you can without pressing the fire against 
her person ; or if you can immediately put out the fire by 
catching up a rug or some heavy woolen thing and envel- 
oping her in it, do so. Remember at the same time to 
avoid inhaling much of the flames or setting fire to your 
own clothes. 

Burns and Scalds. There are various modes of 
treating burns, but one good general rule is that the 
dressings should be so applied as to exclude the air. If 
the skin is not destroyed or removed, either the bicarbon- 
ate of soda may be applied dry, or in a strong solution ; or 
wheat flour may be applied dry, and the burn covered 
with a thick layer of cotton batting ; or the white of egg 
may be spread over it, and another layer put on as soon 
as one dries, until some six or eight layers are applied. 
If the skin is abraded either olive oil or vaseline or car- 
bolated cosmoline applied and covered with cotton or 
wool is a good dressing. (F. 187, 214.) 



Emergencies. 293 

Burns produced by strong acids should be first 
bathed with sonic alkaline solution such as soda or am- 
monia ; on the contrary if lime or caustic potash cause 
the injury, neutralize the alkali by applying acid diluted ; 
a teaspoonful of vinegar or lemon juice in a teacupful of 
water would suffice. 

If a bad scald is occasioned by a child falling back- 
ward in the water, carefully undress the child ; lay it on 
a bed on its breast if the burn is on its back ; then dust 
over the parts with bicarbonate of soda ; lay muslin or 
cotton wool over it, and so arrange the bed by means of 
two boxes and a board that the covering cannot press on 
the scald. 

If a FRAGMENT OF LTME GETS INTO THE EYE, bathe it 

immediately with a weak solution of vinegar or lemon 
juice. 

If something like dust or dirt gets in the eye, it may be 
cleaned out by taking hold of the eye lash and pulling the 
upper lid down, and forcibly blowing the nose. You 
may sometimes wipe the dirt from the eye with a soft 
handkerchief. Always wipe the eye towards the nose. 

When something like a pea or cherry pit is in the 
nostril direct the patient to draw in a full breath, then 
close the mouth and the other nostril and try to blow the 
offending object out. If he fails you can probably remove 
it by means of a hair-pin ; or while the other nostril is 
closed, blow forcibly into the mouth and dislodge the 
object. 

Remove insects from the ear by oil or tepid water. A 
little oil or glycerine may first be dropped into the ear ; 
and then it may be syringed with warm or tepid water, 
taking care not to close the opening with the nozzle of 



294 Mother, Nurse and Infant. 

the syringe. This may be tried if the substance in the 
ear is hard. 

If a child is choked let it get on all fours and cough. 
Anything stuck or lodged in the throat may sometimes be 
worked out with a hair-pin or bent wire. 

If a crochet needle's hooked point is in the flesh 
make certain on which side the hook is, then put an ivory 
bodkin or any similar article down to the hook, and draw 
both out together. 

If a finger or thumb is cut in two, without, any 
crushing of the parts, the severed portion should be im- 
mediately applied to its place ; if the cut is clean, the 
hewn off part may be made to unite, possibly if it has 
been off for two hours. The wound should be washed 
with carbolic solution if that is immediately procurable, 
and the severed parts should be accurately fixed by 
sutures (stitches) in their normal position, and a splint 
applied. 

Life is sometimes destroyed suddenly by persons drink- 
ing a large quantity of cold water when greatly fatigued. 
To avoid all danger in these cases, a small quantity 
should be sipped at a time ; and washing the face, hands 
and temples before drinking is a good precaution. 
But if by drinking cold water the system is severely 
chilled so that prostration takes place, endeavor to secure 
warmth by giving a teaspoonful paregoric, and rubbing 
the hands and body briskly ; and if the patient can be 
brought sufficiently to his senses he should be made to 
drink enough warm water to induce vomiting ; this ex- 
cites circulation and perspiration, and determines towards 
the surface. Warm applications should be made to the 
feet and to the region of the stomach, and the body 
should be warmed as soon as possible. 



CHAPTER III. 

SLIGHT HURTS AND AILMENTS. 

There are a hundred little accidents liable to occur in 
a household which a very little surgical skill would suffice 
to set right. 

Besides medicines, there are several handy articles 
which should be always kept ready in a clean drawer, 
should an emergency arise that demands their use. Have 
a little case containing a lancet, scissors, pins, needles 
and thread ; have also one or two bandages, some lint 
and oiled silk, a bit of lunar caustic (nitrate silver), and 
some strips of adhesive plaster, a stimulant lotion, an eye 
lotion, a liniment, and one or two kinds of ointment. 

Use the lancet to open small abscesses or gum boils ; 
the pins are handy for fastening bandages, &c, and 
should be of different sizes ; the thread should be strong 
and white ; the needles of fair size, with good large eyes ; 
charpie may take the place of lint ; it is made by scraping 
old linen ; it is often useful ; for instance, to heal old 
sores, dip lint or charpie in clean, cold water, to which 
a few drops of carbolic acid has been added ; then apply 
it to the sore, which it must more than cover ; then apply 
oiled silk and a retaining bandage. The lint may be used 
for water dressings to wounds, and these may take the 
place of poultices in treating swellings which we wish to 
reduce or soothe. 

Keep the best adhesive plaster procurable ; and it 
ought to be cut up into different breadths. When it is 

295 



296 Mother, Nurse and Infant. 

necessary to use this plaster, see that the wound is per- 
fectly clean, and apply long narrow slips. Warm the 
plaster by holding it against a can of boiling water for a 
few seconds, then apply it across the wound. In case of 
scalp wounds the hair must be cut off before the plaster 
is applied. 

In a case of fractured ribs, strapping should be applied 
to the injured side. 

Lunar caustic is used to cauterize dog, or cat, or 
skunk bites that are supposed to be poisonous. 

An excellent lotion for headache and other pain is 
made of a quart of water, a teacupful of common salt, 
one ounce of hartshorn, and a half ounce of spirits of 
camphor ; mix and keep in a bottle tightly corked ; satu- 
rate a cloth and apply to seat of pain. 

That form of conjunctivitis (sore eyes), which occurs in 
new-born infants, is in the vast majority of cases, easily 
removed by lukewarm water, or by such simple astringents 
as alum and borax. (F. 193, 215, may be properly kept 
in the house for ordinary sore eyes.) Of course severe 
cases require skilled treatment, but in all ordinary cases 
careful wiping away of the secretion, the use of the alum 
solution, and the greasing of the skin to avoid excoria- 
tions, are in order. For cedematous inflammation with 
little purulent or mucous secretion, but with the tissues 
loaded with serum, a dilute wash of the witch hazel ex- 
tract acts very beneficially. 

The teeth of children when they are pressing on the 
gums and trying to make their way out, should sometimes 
be lanced by cutting the gums. Cut down to the new 
tooth until it is felt under the lancet ; for incisors and 
cuspids a straight line ; for molars a cross cut. 

The best way to do it is — let the operator and nurse 



SPRAINS. 2^7 

sit opposite each other, close together ; the child is laid 
down face upwards, its head in the operator's lap, and its 
feet in the nurse's lap ; the nurse holds the limbs of the 
child quietly ; with his left hand the operator takes the 
jaw between his fingers, and then slowly and firmly does 
the cutting. As the child is still, there is no false cut. 

Sprains caused by a twisting of the ankle cause very 
much pain, although there is no displacement of bone. 
When it first occurs, put the foot and ankle in hot water 
and let it remain for an hour in water as hot as can be 
borne ; then wrap the part in several folds of flannel 
which have been wrung out of hot water, and cover it 
with a dry bandage, and let it rest for several days, keep- 
ing it elevated as high as may be comfortable. When 
first used again, support the joint by strapping. Strips of 
adhesive plaster cut an inch wide, may be applied both 
above and below the joint. It may be best to renew the 
straps every day, — the hair should be shaved off before 
the plaster is applied. 

There are many little ailments that may be cured 
or relieved by regimen- or by such articles as are in every 
house. 

WATER. 

A glass of hot water taken in the morning before 
breakfast washes off a coating which is sometimes adher- 
ing to the lining membrane of the stomach, and affecting 
the digestion. 

Hot water after continuous application renders great 
service to the weary eye and cures the slighter maladies 
of the eye. If an eye is contused and blackened, foment 
the parts continually with hot water until the pain ceases, 
then keep the eye wet with a lotion, or bind on a bit of 
lean, fresh beef, to remove the dark discolored spot. 



298 Mother, Nurse and Infant. 

The itching of pruritis may be much relieved by the 
application of a cloth wet in hot water. 

The hot foot bath is especially efficacious for some 
headaches. If the head is filled with blood and the 
temples throb, soak the feet in very hot water in which 
a spoonful of ground mustard or of salt has been stirred. 
The blood will be drawn from the head and relief ob- 
tained. 

For those who are troubled with excessive sweating, 
tepid sponging of the neck, face, chest and hands with 
equal parts of vinegar and water at bedtime is useful and 
agreeable. 

Convulsions may frequently be cut short by turning 
the patient on the left side ; but as soon as possible put 
the feet in a basin of warm water in which is a little mus- 
tard, and apply a cloth saturated with cold water to the 
forehead. 

A woman who suffers acute pain in the pelvic region a 
few days antecedent to the menstrual flux, should take a 
warm sitz bath of fifteen minutes' duration before re- 
tiring at night. 

The enema of tepid water may be useful in consti- 
pation, and in looseness of bowels, in spasmodic colic, 
and in painful menstruation ; also for piles. The tem- 
perature of the enema should be agreeable to the patient. 

The itching that accompanies many skin diseases is 
much reduced by a warm bath containing a handful of 
borax, and a handful of bicarbonate of soda, in about 
thirty gallons of water. 

Those who practice daily bathing, and indulge freely in 
cold water, are seldom troubled with a cold. Frequent 
bathing, the head being well dipped, will brace the system 
and render a person proof against draughts. 



Cold Water. 299 

There are many. obstinate affections of the head that 
have been known to give way to affusion of cold WATEK 
upon the part. For inflammation of the brain, headache, 
earache, drunkenness, delirium tremans, the delirium of 
fever, epilepsy, rheumatism of the head, diseases of the 
eye, deafness, loss of smell and taste, and in nose bleed 
this remedy may be brought to bear. One mode of taking 
the head bath is for the patient to lie down, placing the 
back of his head in a shallow dish filled only an inch or 
two with water. 

The wet girdle is a useful medical appliance to give 
tone and strength to certain parts. Two and a half or 
three yards of good toweling with tapes arranged at one 
end, the corners of which have been turned over so as to 
form a point, is a good girdle. It should pass about 
three times around the body ; one-half having been wet 
and put on so as to have two thicknesses of the wet part 
upon the abdomen and one upon the back. The girdle 
may be worn every day, but the folded wet sheet is used 
for a time in febrile diseases, such as inflammation of the 
lungs, or of the bowels, colic, cholera morbus, &c. Fold 
a common coarse sheet four double ; wet two thicknesses 
of this in cold water to come next the body ; have the 
patient lie in bed with the four thicknesses around her, 
using warm bricks, bottles, &c, for the feet. 

A table spoonful of charcoal powdered, stirred into a 
glass of water and drank at once, is excellent in many 
cases of headache from sour stomach, flatulence, &c. 

Children who complain of choking sensations in the 
throat (caused by worms), may find relief from swallow- 
ing salt and water. 

Those who are suffering from dysentery should have 



300 Mother, Nurse and Infant. 

a little wheat flour stirred into the water that they 
drink. 

TAR WATER. 

Every body ought to have tar water in the house. 
It is made by adding one pint of wood tar to four pints 
of cold water, mixing thoroughly and shaking frequently 
during twenty-four hours, and then filtering the water 
which may be poured from the tar. Given internally it is 
stimulative in its action, and acts somewhat upon the 
kidneys ; is useful for cough and hoarseness, and for in- 
cipient urinary difficulty ; locally applied it is slightly 
astringent, antiseptic and disinfectant ; and by destroying 
the putrefactive germs, it prevents or restrains the process 
of suppuration. It is especially useful in puerperal septic 
diseases, as it is antiseptic and disinfectant ; the resinous 
principle which it contains, exerts a healing action upon 
the genital lesions, and suppuration is prevented. It may 
be used three times a day as a vaginal. wash during the 
lying-in period, and cloths used to protect the vulva and 
receive the discharges should be moistened with it. It is 
a useful local application in the treatment of various 
diseases of the vulva and vagina, especially for the horri- 
ble itching of pruritis. Its use renders innoxuous the 
irritating discharges, and its sedative and alterative action 
restrains and stops the morbid process. It has a curative 
value in skin diseases, and in general it may be used in 
the various cases where carbolic acid is usually prescribed. 
Other medicine may be dissolved in it. 

SALT WATER. 

Salt is a promoter of health and longevity, and people 
generally who like salt, vinegar, &c, should be allowed 
to gratify their taste. If the blood is too rich, salt may 



Carbonate of Soda. 301 

restore it to a normal condition ; and may restore to it 
the needed elements if the blood is impoverished. One 
of the best remedies for spitting of blood is to drink a 
little salt water. 

For persistent bleeding from the nose, cut a piece of 
raw fat salt pork, about four inches long, and near half 
an inch thick and over half an inch wide, wedge shaped 
at the ends, and force it through the nostril clear back to 
the pharynx. 

A teaspoonful of salt taken just before a fit of the ague 
may effectually break up an intermittent fever, and pre- 
vent a recurrence of the chills. 

A spoonful of vinegar with salt in it is an excellent 
remedy for dysentery. 

CARBONATE OF SODA AND WATER. 

Probably the anesthetic, antiseptic, and disinfectant 
property of bicarbonate of soda is. due to the ready disen- 
gagement of carbonic acid from it. For burns and 
scalds where the skin is not broken, powdered bicarbon- 
ate of soda may be strewn over the burned parts. If the 
burns are deep and attended with much suppuration, 
linen rags sprinkled with a solution of the soda (1 to 50) 
should be laid on, and as soon as these rags become dry, 
they should be replaced by others, or be moistened again 
in the solution. But for most burns the rags should be 
kept on constantly, and moistened by pouring the solu- 
tion over them, as changing the compresses would cause 
more suppuration and delay the healing process. 

If a hand or foot is burned, and soda, &c, is not ob- 
tainable, it may be kept immersed for a considerable time 
in cold water with a salutary effect. 

A teaspoonful of baking soda taken each day, dissolved 



302 Mother, Nurse and Infant. 

in a pint of water, is a good remedy for habitual consti- 
pation. 

HONEY AND TAR. 

"For the bites of reptiles (rattlesnakes, moccasins, 
&c), give the patient about a gill of strained honey every 
ten or fifteen minutes until vomiting is produced." 

A table spoonful of powdered charcoal mixed with 
honey, milk, or cold water, and taken every morning will 
tend to cure any one who is troubled with either consti- 
pation or diarrhoea. 

OIL. 

The application of oil to the whole surface of the body 
is a simple method of treatment of such infantile com- 
plaints as ATROPHY, BRONCHITIS, CONVULSIONS, DIAR- 

rhcea, and febrile disturbance generally. Smear 
salad oil all over, from the crown of the head to the 
toes, three or four times a day. 

For pruritis ani rub on linseed oil freely at bedtime 
each night. 

spirits nitre. 

For rhus poisoning (poison oak) apply sweet spirits 
of nitre. Where the discharge of urine is attended 
with heat and pain, pound a handful of melon or pumpkin 
seed with a lump of white sugar, add a quart of boiling 
water, then add half an ounce of spirits of nitre and rub 
them together. A teacupful may be taken every two 
hours by adults. 

other remedies, regimen, &c. 

For strangury use bee tea made by pouring a pint of 
boiling water on fifteen or twenty honey bees. 

For erysipelas apply cranberries locally, either cooked 
or uncooked. Another good local application for erysip- 



Remedies and Regimen. 303 

elas is elderflower tea. Linen cloths wet with the 
cold infusion should be applied, and before they are dry 
should be wrung out of clean water, then dipped in the 
infusion and reapplied. The patient should also drink 
some of the elder flower tea. (F. 177.) 

For bee and wasp stings apply the tincture of arnica, 
or sweet oil. 

Lean fresh meat is the best absorbant substance to 
apply to relieve the pain of a wasp sting. 

"To give relief to a child that has the earache close 
the mouth and blow into the nose." 

Children suffering from whooping cough should inhale 
the vapor of turpentine. Place this on plates and allow 
these to stand in the room. 

Where there are suppurative discharges from the 
ear, the dry dressing with absorbent cotton, after dry 
cleansing with the same, protects the wound from the air, 
and attracts the discharge from the middle ear. It is 
mildly stimulant and conduces to healing. 

For soft corns wear loose shoes, and every morning 
place a little absorbant cotton between the toes. 

For mosquito bites apply a mixture of carbolic acid 
and glycerine in the proportion of one of the former to 
twenty of the latter. 

For the vomiting which often complicates cases of 
consumption and chronic bronchitis, give three or four 
grains of alum in a little ginger tea every three or four 
hours. 

Inhalations of steaIvi are useful in quinsy ; and all 
affections of the throat that are painful, are much relieved 
by inhaling steam impregnated with the oil of peppermint. 

Tea and coffee are of some value in nervous head- 



304 Mother, Nurse and Infant. 

aches produced by cerebral congestion, and are indicated 
when the face is flushed. 

A weak solution of common salt snuffed up into the 
nose daily, is a remedy for chronic catarrh ; if a de- 
coction of green tea is snuffed up immediately after- 
ward the remedy is more effectual. 

Cold tea is a good mild astringent application to sore 
eyes. 

Patients who suffer at night from cramps may find re- 
lief by having the head of the bed raised. Cause the 
head of the bed to be raised the thickness of two bricks. 

Those persons who are troubled with dizziness after 
smoking early in the morning, may avoid it generally by 
not smoking until after eating. 

To remove needles, nails, &c, from the extremities, 
make a small incision at the place of entrance through 
the skin, and with an obtuse pointed stick, and the 
stronger solution of carbolic acid on the end of it, by a 
boring action penetrate to the necessary depth, occasion- 
ally making search with a metalic probe to learn of its 
whereabouts. When reached remove with small forceps. 

For pruritis pudendi, neuralgia, toothache, sick- 
ness and vomiting, when these are due to the pregnant 
state, apply a blister to the back, over the fourth and fifth 
dorsal vertebra. 

Children who are exceedingly short sighted, may by 
wearing glasses be benefitted, not only physically but 
mentally ; becoming more active and lively and less re- 
served and tacturn. A child may be thought a dullard, 
and to have no aptitude for observation or learning, be- 
cause his misfortune is to have bad sight ; and such a 
character may be fastened upon him for life, because in 



Magnifying Glasses. 305 

his young days he was cut off from the enjoyment of the 
visible world which his fellows were favored with. 

Occulists say that when with the arrival of middle life 
the focusing power of the eye declines so far that at the 
usual distance for reading, a sufficient adjusting force no 
longer exists, it is the preferable thing to put on weak 
magnifying glasses, to take off strain, rather than to 
postpone their use as long as possible. My own opinion 
is that when a man can, by sitting with his back to the 
window and holding a book in the light, at the usual dis- 
tance from the eye, read the fine print of the newspapers, 
it is better to avoid wearing magnifying glasses. But we 
should always be careful to have the light shine on the 
paper, and not on our eyes when we are reading. 

Many invalids, especially those who suffer from uterine 
disease, are distressed to find that they begin to fail to 
command the services of their eyes. When persons are 
recovering from any severe illness such as fever, or from 
protracted exhaustion, or after prolonged lactation, or 
watching with invalids, or great loss of sleep ; where 
there has been much grief and weeping, or a severe men- 
tal strain, or loss of blood, or in severe or chronic dys- 
pepsia, impaired eye power is pretty sure to appear. 
The essential condition to recovery lies in restoration to 
vigor, and sound health, and habits. 

They can probably develop and recover their ocular 
energy by the graduated use of their eyes, beginning with 
short periods and advancing by small additions. 

Ladies that suffer from painful menstruation should 
not read in bed at the time of the menstrual flow. Weak- 
ly persons should not read while lying down ; and to 
them umbrellas, and parasols, and colored glasses become 
needful as protection from the sun and wind. For such 



306 Mother, Nurse and Infant. 

it is hurtful to read in railway cars or in carriages ; and to 
them an atmosphere of smoke, or the air of an ill venti- 
lated, crowded, or brightly lighted room is injurious. 

For sleeplessness the best remedy is to so regulate 
the breathing that it shall induce the right circulation 
in the brain, and the repose of the faculties. In breath- 
ing have the inspirations and expirations of equal length, 
and it will at least conduce to the repose of the brain. 

For a slight illness all that you need to do very of- 
ten is to breathe full, so as to make deep inspirations for 
half an hour ; and you can rear healthy children if you 
can secure to them good round chests. To do this, first 
measure each of them with a tape ; then teach them to 
practice forced inspiration through the nostrils several 
times a day ; offer a prize for the first inch gained in cir- 
cumference. Flat chested children will soon grow round 
and full, and the breathing space large. The result will 
be good health of the children. 

A child not more than four years old is sometimes 
afflicted with diabetis ; this is usually due to farinaceous 
food, and the child should be debarred from starchy food 
and sugar. 

One important means to arrest bleeding from the 
nose is to put a tight ligature on a finger or on a larger 
limb. An attempt may also be made to check the hem- 
orrhage by firmly grasping the nose with the finger and 
thumb, so as to prevent any air from passing through the 
cavity. 

A gargle of strong black pepper tea used freely 
will sometimes be an effectual remedy for aphonia, when 
the patient is not able to speak louder than a whisper. 



CHAPTER IV. 



DIETETICS FOOD FOR CHILDREN. 

But little pure milk can be obtained in cities, and a 
substitute may sometimes be used ; but where good milk 
can be obtained, it may usually be made the principal 
food of young persons. 

The mother's milk, if the mothers are healthy, is the 
best food for infants ; and those that nurse should not as 
a general rule be weaned during the summer months, 
when diarrhoeas most prevail. When the mother has a 
sufficient quantity of milk, an infant requires and should 
receive no other food but breast milk until the sixth and 
perhaps the ninth month, when other food than breast 
milk must be provided. New-born babies until the age 
of twenty-one days should be fed with one part of milk 
to three of water ; between the ages of three and six 
weeks, with one of milk and two of water ; from six 
weeks to three months, two of milk to three of water ; at 
three months, half milk and half water ; at six months 
three of milk and one of water. It should be good new 
milk, and the water should be warm, or only hot enough 
to bring the temperature to that of breast milk. 

This diet is better than any variety of starch food, but 
if the best milk that is obtainable does not agree well 
with the child, a light gruel made from any of the deriva- 
tives of starch may be substituted for water in the above 
admixtures. If a feeding bottle is used, the food should 
be given at regular intervals, as has been heretofore 



308 Mother, Nurse and Infant, 

directed in regard to nursing. As soon as the child's 
meal is over, the tube should be removed from its mouth. 
The bottle and teat should be thoroughly washed after 
each meal, and the former always kept in a basin of cold 
water when not in use. A sweet feeding bottle is of great 
importance, and neglect of scrupulous attention to it is a 
frequent cause of sickness in a child. 

A few more general directions will be given to afford 
some guide under varying circumstances. 

The degree of dilution of the milk may vary with the 
richness of the milk used. 

When the mother gives evidence of feebleness it may 
be best to wean the child at six months, or even sooner 
if the mother evidently suffers from lactation. If the 
mother's health is robust it may be well to nurse it to the 
twelfth or thirteenth month, but we should always en- 
deavor to know whether the child thrives best on the 
mother's milk. Before the twelfth month she should 
gradually diminish the allowance of the breast, and in- 
crease the supply of suitable food ; perhaps suckling the 
child twice in the twenty-four hours, and otherwise feed- 
ing it at proper intervals. 

If the child is weaned at seven or eight months or later, 
it may take for a meal a breakfast-cup full of milk to 
which is added a teaspoonful of lime water, or a weak 
solution of soda ; and sometimes it may take the yolk of 
an egg well beaten up in a teacupful of milk, or a dessert 
spoonful of pearl barley jelly dissolved in a breakfast-cup 
full of warm milk, and slightly sweetened with white sugar. 

Food for infants or for the sick should neither be 
rewarmed nor kept warm on a stove or in an oven, espec- 
ially if either sugar or salt has been added to the compo- 
sition ; it is better to prepare no more than is required at 



Dietetics. 309 

once, but if any should remain and be used, let it be 
brought to a proper warmth by the addition of a little hot 
water, broth, or gruel, as the case may be. 

Food made of bread so as to constitute pap or panada 
has a great tendency to become sour, and a quantity only 
sufficient for a single meal should be made at a time. 

Oatmeal and Indian meal have a loosening effect 
upon the bowels, but these as well as wheaten bread, con- 
tain more nutritive matter than sago, tapioca, and similar 
substances which may be regarded as modifications of 
starch. 

For the sick have hot things very hot, and cold things 
very cold. Food should never be prepared in the pres- 
ence of the sick, nor so that the smell of cooking be al- 
lowed to reach them if it can be avoided. 

Never taste of the patient's food in her presence or 
with her spoon ; give food regularly, but in most cases 
the patient should not be roused from sleep for food ; 
some light food at night will often serve to send the pa- 
tient to sleep. 

Rice forms an excellent diet for the sick and for con- 
valescents. 

COOKING FOR THE SICK AND FOR YOUNG PERSONS. 

Preliminary remarks. Cleanliness is eminently es- 
sential in cooking for the sick and for infants. The ves- 
sel in which milk or gruel is boiled should not be used 
for anything greasy or seasoned ; a sauce pan in which 
broth has been made, flavored perhaps with onions or 
parsley, unless very nicely cleaned will impart a disagree- 
able taste to delicate food. Whatever vessel is used the 
food should not be allowed to remain in it, but should be 
poured out as soon as done, and the vessel put to soak in 



310 Mother, Nurse and Infant. 

cold water. If it is of tin it should soon be cleansed with 
wood ashes, but enameled sauce pans or granatized iron 
ware may be washed clean ; when taken down for use 
wipe with a clean, dry cloth. 

For stirring use either a silver or wooden spoon ; not 
one of iron or other metal. 

The earthenware dishes, basins or whatever else may 
be used for keeping food already cooked, or for milk, 
should be scalded after using, made perfectly dry with a 
clean cloth, and left to become quite cold before milk 
broth or whatever it may be, is put into them. For pre- 
serving liquids (broth, gruel, or milk), a wide, shallow 
vessel is better than a thin, narrow one ; milk should 
never be kept in a jug ; cooked food should not be shut 
in with a lid ; a hair sieve, or wire cover, or common 
colander may preserve from cats, mice, slugs, &c. 

The cake of fat which collects on the top of broth tends 
to preserve the liquor while it remains unbroken ; but if 
the skin or fat at top is broken, and if the broth or gruel 
is designed for use at a subsequent meal, the fat should 
be removed, and the remainder should be transferred to 
a clean, dry vessel. 

FOOD FOR CONVALESCENTS. 

Many questions in regard to diet are left by the physi- 
cian to the nurse, especially while she has the care of 
convalescents. I give for her guidance a few more 
aphorisms and directions : 

i. While it is true that as a general rule people who 
like salt, vinegar, &x., ought to be allowed to gratify their 
taste, and that the cravings of a sick person are not al- 
ways to be denied, yet appetite and taste were intended 
to govern the choice and quantity of food in health ; and 



Food for Convalescents. 311 

even then, they should be guided by reason and experience. 
Such articles as fruit, jam, cake, cheese, butter, and milk 
may generally be taken if there is a craving for them, but 
if they are not digested, the stomach must be consulted, 
and not the cravings. Milk and eggs are important arti- 
cles of food, but they must not be forced upon the 
patient ; cheese is sometimes craved ; it is concentrated 
nutriment, but in some person's stomachs it is digestible, 
and it may perhaps favor digestion of other food ; do not 
entirely disregard the desires and taste of the patient ; as 
a rule if meat is craved it is allowable, and it is better to 
chew and swallow it, than it is to chew it and spit out its 
nutritive contents. 

2. During convalescence, as soon as animal food 
can be taken with impunity, that which is most digestible 
should be selected. With the exception of poultry the 
flesh of middle aged animals affords the most digestible 
food. Keeping animal food for a certain time before it 
is cooked lessens the density of the fibre and renders it 
more tender, but the utmost caution is requisite to pre- 
vent the change from advancing so far as to present the 
slightest trace of taint in the food. 

3. Gellatine in the form of bouillon or concen- 
trated broths is valuable in fevers, &c, as an addition to 
other diet, as it prevents or rather retards the process of 
denutrition. 

4. Sour milk is to some sick persons and convales- 
cents an agreeable beverage, and in cases of atonic dys- 
pepsia and many other cases, it is a good adjuvant in the 
treatment of slow digestion, where flatulence and a sen- 
sation of cramp in the stomach are prominent symptoms. 
The good effects of N drinking a tumbler full or half a tum- 
bler full of ordinary cold sour milk or buttermilk, is 



312 Mother, Nurse and Infant. 

probably owing in a measure, to the lactic acid which it 
contains. It may be taken regularly half an hour after 
each meal, in cases of weak stomach. 

5. Milk is digestible when it is drunk immediately 
after it is drawn from the udder of the cow or that of the 
goat, but it is often necessary in convalescence to dilute 
it in water. It may be kept for some time from souring 
in warm weather by adding to each quart fifteen grains of 
bicarbonate of soda. When there is evidence of over- 
acidity of the stomach, lime water may be added in any 
proportion up to one-half. 

Raw egg somewhat in the form of an emulsion, has 
been useful in certain diseases. Four raw eggs may be 
beaten up in a pint of cold water, a little flavoring and 
sugar added, and the patient may take it by sips during 
the day. This is a light and nutritive diet, but eggs are 
much less digestible in this form than wften they are 
lightly boiled. 

Raw oysters are somewhat nutritive, but are not easy 
of digestion. Lobsters, crabs, sprawns, crayfish, 
scallops, and other shell fish are more objectionable than 
oysters. Fish, especially of the white kind, is not stimu- 
lating ; if it is simply boiled it is admissable for convales- 
cents, and for those laboring under some acute diseases. 
In the decline of fevers some animal food may be given ; 
first beef tea, chicken broth, and mutton broth, and other 
liquid animal decoctions ; then white fish and a more 
generous diet. 

8. The value of soups depends upon the freshness of 
the meat, the manner in which they are boiled, and the 
delicacy with which they are seasoned ; for the latter any 
of the vegetable condiments may be used according to 
the taste of the consumer. 



Aliments. 313 

9. The nurse should know that certain articles in a 
certain form cannot be digested in the stomach, because 
they cannot be dissolved in the fluid contained there. 
Rich pastry, pieces of hard potato, rich puddings and 
dumplings, hard stringy meat, and greasy fibred meat, 
new bread, and rolls that are not well baked are, in gen- 
eral, indigestible. Pie is not essentially indigestible ; in- 
deed indigestibility cannot be affirmed of any article of 
food, apart from a consideration of the digestive capacity 
of the particular stomach, the powers of which are to be 
tested. 

10. Some mild esculent roots are fitted for the 
use of the sick if they are boiled in two waters, but they 
are not well adapted to those who are liable to sour 
stomachs. Some vegetables, on account of their peculiar 
qualities, have peculiar effects as remedies. It is asserted 
that spinach and asparagus act as diuretics, dandelion as 
a tonic and laxative, tomatoes as a cholagogue, beets and 
turnips as a tonic, onions, garlic, and leeks as stimulants 
and narcotics, the red onion as a narcotic in neuralgia 
and insomnia, and cabbages, tomatoes, and other salad 
material as anti-scorbutics. 

n. Fruits produce the most diversified effects ; but 
peaches and nectarines, very soluble pears if they are ripe, 
apples if they are roasted, the orange if it is fully ripe, 
grapes if the skin be rejected, strawberries and mulberries 
are pretty generally admissible. 

FLUID ALIMENTS. 

12. Fluid food can in most cases be taken more con- 
veniently by suction through a bent glass tube. After 
feeding, dry the mouth if the patient cannot well do it for 
herself. 



314 Mother, Nurse and Infant. 

13. Water is demanded in every disease in which a 
dry skin and an elevation of temperature is present. 
The temperature of the water may be from 6o c to 50°. 
Small bits of ice swallowed whole are excellent to control 
nausea. It is refreshing and harmless. 

To keep a small piece of ice from immediately melting : 
Cut a piece of flannel six inches square, snip one or two 
holes in the centre for water to run through ; confine it 
by an elastic band about the edge of a tumbler or goblet ; 
depress the middle of the flannel, and a small piece of ice 
may be kept in it for some time*; bits of ice may be split 
off from it with a knife. Ice and water should be pure. 

14. Toast water when properly prepared forms a use- 
ful beverage in the sick room. As it contains a small 
proportion of gluten it is slightly nutritive. 

15. While febrile symptoms are present, farinaceous 
matters such as barley water gruel, arrow root, mucilage 
or sago acidulated with lemon juice, and sweetened to the 
taste of the patient, are most commonly suitable, but 
water is the most salutary diluent. 

16. Gruel is less mild and demulcent than barley 
water, and is more likely to sour, but it is nutritive food. 

17. Tea is refreshing, and may be taken in moderate 
quantity, provided it be not strong. Coffee may be taken 
largely combined with milk. 

18. Beer, brandy, and other stimulants should be 
given only after proper medical examination and advice. 

Recipes for Beverages and Food. 

formula i. food for infants. 

Take of new milk, warm water, of each equal parts ; 
table salt, sugar, of each a small quantity, to salt and 
sweeten it slightly ; warm the milk by the water, so that 



Recipes for Food. 315 

it will be of the same temperature as the mother's milk 
— about 90 ; the proportion of milk may be a little less 
than this when the infant is newly born, and should be 
increased as it grows older, but water must always be 
given with the milk. Give by means of a feeding bottle 
that has been properly cleansed. 

2. GUM ARABIC MUCILAGE. 

Take of gum Arabic one ounce, boiling water one pint ; 
after the gum Arabic is dissolved, add two table spoon- 
fuls of sugar and the juice of a lemon ; cool and add ice. 
This may be taken as a drink in diarrhoea. 

3. INFUSION OF FLAX SEED. 

Take of flax seed two table spoonfuls, water one pint, 
sugar two table spoonfuls ; steep for an hour or more 
and strain, then add the juice of a lemon and set on ice. 
Use as a demulcent drink. 

4. MILK AND CINNAMON DRINK. 

Take of cinnamon one teaspoonful, boiling water one 
pint ; steep for a few minutes, sweeten with sugar, and 
mix with half a pint of milk. Good in diarrhoea. 

5. VINEGAR WHEY. 

Take of milk one pint, vinegar one ounce ; boil for a 
few minutes and separate the curd. Good in dysentery, 
and may be taken freely. 

6. DECOCTION OF BRAN. 

Take of wheat bran one pint, boiling water three pints ; 
let the mixture stand in a covered vessel for two hours ; 
strain and serve, with sugar and cream. This is slightly 
laxative. 



316 Mother, Nurse and Infant. 

7. SAGE TEA. 

Take of the dried leaves of sage half an ounce, boiling 
water one quart ; infuse for half an hour and then strain. 
Sugar and lemon juice may be added in the proportion 
required by the patient. In the same manner balm and 
other teas may be made. 

8. A REFRESHING DRINK IN FEVERS. 

Boil one ounce and a half of tamarinds, three ounces 
of cranberries, and two ounces of stoned raisins, in three 
pints of water till the water is reduced to two pints ; 
strain and add a bit of lemon peel, which should be re- 
moved in an hour as it gives a bitter taste if left long. 

9. TOAST WATER. 

Take slices of toast nicely browned, enough hot water 
to cover them, cover closely and let them stand until cold ; 
strain the water, sweeten to taste, and put a piece of ice 
in each glassful. If the physician thinks it safe add a 
little lemon juice. Good for nausea and vomiting. 

10. APPLE WATER. 

Take three juicy pippins or other fine flavored apples, 
one quart cold water ; pare and quarter the apples, but 
do not core them ; stew the apples to pieces in a tin or 
porcelain sauce-pan, closely covered ; strain the liquor at 
once, closely pressing the apples in the cloth ; sweeten 
and ice for drinking. Slightly laxative. 

II. SLIPPERY ELM BARK TEA. 

Break the bark into bits, pour boiling water over it, 
cover and let it infuse till it is cold. 

12. JELLY WATER. 

Take one large teaspoonful currant or other kind of 



Recipes for Food. 317 

jelly, one goblet ice water ; beat up well. A good drink 
in fever, and if of wild cherry or blackberry jelly it is 
very good for those suffering from diarrhoea. 

13. CORN TEA. 

Take a cupful of dry corn, parch it brown, grind it, or 
pound it in a mortar ; pour over it two cups of boiling 
water, and steep for a few minutes. This is nutritious. 

14. TARTAR WHEY. 

Take of milk one quart, cream of tartar half an ounce ; 
boil until the curd separates. This is somewhat laxative. 

15. HERB TEAS. 

Take of the dried or green leaves about one ounce, 
boiling water one pint, and let them stand until cold. 
Catnip tea is good for colds and coughs in infants ; spear- 
mint and peppermint tea is good for disordered stomach 
and bowels ; pennyroyal for a cold if recently taken ; 
chamomile tea is a good tonic, blackberry root tea is 
good for summer complaint, raspberry leaves (green) for 
dysentery, sweet apple tree bark tea for a child's cankered 
sore mouth, pumpkin seed and parsley tea for suppres- 
sion of urine ; mullien leaf tea is good in kidney com- 
plaints ; mullien leaves infused in milk makes a medicinal 
drink in a case of phthisis. 

16. MILK AND ISINGLASS (GELATIN.) 

Dissolve a little gelatin in water and mix with half a 
pint of milk. Boil and sweeten to taste. 

17. EFFERVESCING LEMONADE. 

Take the juice of a large lemon, two or three teaspoon - 
fuls of sugar, half a pint of spring water ; add half a 
small teaspoonful of carbonate of soda. Stir and drink 
while effervescing. 



318 Mother, Nurse and Infant. 

l8. INDIAN MEAL GRUEL. 

Take of Indian meal one small teacupful, wheat flour 
one table spoonful, boiling water two quarts ; wet the 
meal and flour to a smooth paste, and stir into the water 
while it is boiling. Boil slowly for thirty or forty minutes, 
frequently stirring from the bottom ; salt to taste ; add 
sugar and nutmeg if you like ; if too thick reduce with 
boiling water to the desired consistency ; if a laxative 
effect is desired omit the flour. Raisins may be boiled 
with the gruel, and cream may be added if desired. 

19. OATMEAL GRUEL 

is made in the same way as the above. Gruel drank 
warm at bed time is a soothing remedy for a bad cold. 

20. MILK AND RICE GRUEL. 

Take boiling milk one quart, ground rice two table 
spoonfuls wet with cold milk, salt one salt spoonful ; stir 
in the rice paste and boil ten minutes, stirring constantly. 
Season with sugar and nutmeg, and eat warm with cream. 

2 1. TAPIOCA JELLY. 

Take of tapioca two spoonfuls, water one pint ; boil 
gently for an hour, or until it assumes a jelly-like appear- 
ance. Add sugar and nutmeg with lemon juice to suit 
the taste of the patient. 

22. RICE GRUEL. 

Take of ground rice one ounce, cinnamon one drachm, 
water one quart ; boil for thirty minutes, adding the cin- 
namon near the conclusion. Strain and sweeten it. 

23. PANADA. 

Take of wheat bread one ounce, cinnamon one drachm 
(or if preferred a little mace), water one pint ; boil with - 



Recipes for Food. 319 

out stirring until they mix and turn smooth. Then add a 
grate of nutmeg, a small piece of butter, and sugar ac- 
cording to taste. Some add a table spoonful of wine. 

24. BREAD JELLY. 

Steep stale bread in boiling water, and pass through a 
fine sieve while still hot. This is a light, nourishing diet 
for a weak stomach, which may be taken alone, or after 
being boiled with milk. 

25. RICE CREAM.. 

Steep a quarter of a pound of whole rice in milk, and 
put in a sieve to drain and cool ; mix the rice with a gill 
of cream whisked to a froth, and a little powdered sugar, 
and a teaspoonful of lemon juice. Some add wine but it 
is not necessary. 

26. TO MAKE FAT. 

The diet to be prescribed when the aim is to produce 
increased weight should include such articles as fat meats, 
butter, cream, milk, cocoa, chocolate, bread, potatoes, 
peas, parsnips, beets, farinaceous and flour puddings, 
pastry, almond puddings, and biscuit, custards, oatmeal 
porridge, sugar and sweets, porter, &c. 

27. MILK PORRIDGE. 

Take wheat flour two table spoonfuls, milk one pint, 
water one pint ; mix the flour with cold water to form a 
thin paste ; put the milk and water over the fire, and 
when they come to a boiling point add the paste, carefully 
stirring. 

28. FRENCH MILK PORRIDGE. 

Stir some oatmeal and water together, let the mixture 
stand to clear, and pour off the water ; then put more 
water to the meal, stir it well and let it stand till the next 



320 Mother, Nurse and Infant. 

day ; strain through a fine sieve and boil the water, add- 
ing milk while so doing. Let the proportion of milk 
exceed one-half. With toast this is good diet for the sick. 

29. LIME WATER AND MILK. 

Take of lime water one to two ounces, milk four 
ounces. This will sometimes be retained on the stomach 
when other food is rejected. The addition of fifteen 
grains of bicarbonate of soda has a similar effect if added 
to a quart of fresh milk, and prevents milk from turning 
sour for several hours. 

30. MUSH AND MILK. 

Take of Indian meal one coffee cupful, water two 
quarts, salt to taste ; when the water is boiling, stir the 
meal into it, adding meal gradually till it thickens so that 
it is difficult to stir. It should be permitted to remain 
where it will cook slowly for twenty or thirty minutes, 
stirred often with a pudding stick. Eat with milk. 

31. LEMON JELLY. 

Soak half a box of gelatin in a cup of cold water ; 
steep the grated or pared rind of two lemons in a pint of 
boiling water for ten minutes, add the gelatin, one cup 
of sugar, and four table spoonfuls of lemon juice. When 
all is dissolved, strain and place in a vessel to cool. 

32. ALUM WHEY. 

Take alum one teaspoonful, milk one pint ; boil to- 
gether and strain to separate the curd. 

^^. TABLE TEA. 

Allow a small teaspoonful of tea to each half pint of 
water. After rinsing the teapot with boiling water put in 
the tea, and let it stand a few minutes in the steaming 



Recipes for Food. 321 

pot ; add the water freshly boiling, and let it stand where 
it will keep hot three or four minutes. 

34. NUTRITIOUS COFFEE. 

Take one pint of nearly boiling milk, and add half an 
ounce of freshly ground coffee, and boil together for three 
minutes. Clear it by pouring into a cup and dashing 
back. Add a little isinglass dissolved in water and leave 
to settle. If preferred, beat up an egg with sugar and 
pour the coffee upon it. 

35. NUTRITIOUS LAXATIVE. 

Take one table spoonful of lump magnesia, pulverized, 
one teaspoonful of saleratus or soda, sugar and salt as 
desired, and stir them in a quart of hot milk porridge 
made in the usual way. This will operate as an antacid 
and as physic if taken during the day ; at the same time 
it is nourishing. 

36. POTUS IMPERIALIS. 

Take half an ounce of cream tartar, the juice of one 
lemon, and two table spoonfuls of sugar ; pour on them 
a quart of boiling water, and let it stand on ice till cold. 
If this is drank it will increase the action of the kidneys. 

37. VEGETABLE SOUP. 

Take one potato, one turnip, one onion ; let them be 
sliced and boiled in one quart of water for an hour. Add 
as much salt and pepper as is agreeable, and pour the 
whole upon dry toast. Add butter if desired. 

38. SWEET PTISAN, FOR A DRINK IN DYSENTERY. 

Take of sheep's suet two ounces, milk one pint, starch 
half an ounce, water one pint ; boil slowly for fifteen 
minutes. 



322 Mother, Nurse and Infant. 

39. mucilage of starch. 
Take of starch one ounce, powdered cinnamon one 
drachm, gum Arabic one ounce, boiling water three pints ; 
boil until reduced to two-thirds and strain. This is a use- 
ful drink in dysentery. 

40. BOILED FLOUR. 

Take of fine wheat flour a pound, tie it up in a linen 
cloth, boil until it becomes a hard dry mass. A table 
spoonful of this may be grated off and used to make milk 
porridge. 

41. TOAST. 

The bread must be cut thin, the crust trimmed off, and 
then the slice held in a toaster over a bed of coals, and 
turned from side to side till all the moisture is removed, 
then allowed to become a golden brown. Serve it on a 
hot plate as soon as it is done. 

42. VERV'NICE PANADA. 

Take three Boston crackers, split them and arrange 
them in a bowl in layers, sugar and salt scattered among 
them ; cover with boiling water, and set in a warm place 
with a close cover over the bowl, to remain one hour. A 
little nutmeg should be added, and it should be eaten 
from the bowl. 

43. HOW TO PREPARE ARROW ROOT. 

Put two teaspoonfuls of the powder into a basin, mix 
them smooth with a few teaspoonfuls of cold water, and 
let another person pour boiling water over the mixture 
while you continue to stir it until it forms a starchy look- 
ing substance. It may be used in the same manner as 
gruel, a little milk and salt being added to it. 



Recipes for Food. 323 

44. ARROW ROOT CUSTARD. 

Take two teaspoonfuls arrow root, wet them up with a 
little cold milk ; stir for three minutes in a cup of boiling 
milk, take from the fire and stir in an egg, already well 
beaten ; boil two minutes longer, flavor with vanilla or 
rose water, and pour into moulds. 

45. BOILED RICE AND COCOA-NUT. 

Take one teacupful of rice, one heaping teaspoonful of 
cocoa-nut, and the milk from the centre of the nut ; one 
quart of water, one pint of milk, and salt to taste ; boil 
three or four hours in a double boiler. If it boils away 
too much add more water. Serve with canned straw- 
berries for sauce. 

46. BREAD JELLY FOR CHILDREN WEANED. 

Take a quantity of the soft part of a loaf, break it up, 
cover it with boiling water and allow it to soak for several 
hours ; the water is then to be poured off completely, and 
fresh water added ; place the mixture on the fire and 
allow it to boil until it becomes smooth. The water is 
then to be pressed out, and the bread on cooling will 
form a thick jelly. Mix a portion of this with sugared 
milk and water as it is wanted. 

47. HOW TO COOK RICE. 

Erratum. On page 268, bottom line, for 47 read 40. 

In preparing it only just enough cold water should be 
poured on to prevent from burning at the bottom of the 
pot, which should have a close fitting cover, and with a 
moderate fire the rice is steamed rather than boiled until 
it is nearly done ; then the cover is taken off, the surplus 
steam and moisture allowed to escape, and the rice turns 
out a mass of snow white kernels. 



324 Mother, Nurse and Infant. 

48. oyster broth. 
Take half a pint of oysters, cut into small pieces, put 
them into a gill of water and let them simmer for eight or 
ten minutes. Skim and strain, then add a little new milk, 
salt, and pepper. 

49. POACHED EGG. 

A fresh egg broken into boiling water and cooked till 
the white is congealed, then laid on a piece of newly 
toasted bread dipped in hot milk and buttered, is an ape- 
tizing dish for convalescents. 

50. CHICKEN TEA. 

To relieve the nausea and vomiting of cholera morbus : 
Kill a chicken, and strip off the feathers as soon as possi- 
ble after it is killed ; boil the wings and legs in a little 
water. This, if simply seasoned with a little salt, will be 
acceptable to the stomach. 

51. RESTORATION SOUP FOR INVALIDS. 

Take one pound of newly killed beef or fowl, chop it 
fine ; add one-half pint of pure water, and perhaps four 
or five drops of pure muriatic acid, one-half teaspoonful 
of common salt, and stir well together. After three hours 
the w T hole may be thrown in a sieve, and the fluid allowed 
to pass through on slight pressure ; on the flesh residue 
in the sieve pour slowly one-half teacupful of water, and 
let it run slowly through the sieve while squeezing the 
meat. There will thus be obtained about ten ounces of 
cold juice (extract of meat), having a pleasant taste of 
soup, of which a wineglassful may be taken at pleasure. 
If preferred one part of meat may be taken with two 
parts of white sugar, one teaspoonful every three hours. 
The two may be pounded in a mortar. 



Recipes for Food. 325 

52. BEEF TEA. 

Take one pound of beef minced very fine, and put it in 
a common earthenware pot with a pint and a half of cold 
water ; stand the pot on the stove, so that it may simmer 
for at least three hours. 

53. CHICKEN BROTH. 

When it is desired that chicken broth should be very 
nutritious, take an old fowl ; cut up and break the bones 
with a mallet ; cover with three or four pints of cold 
water, and add some rice or tapioca ; salt to taste and 
boil for two hours. 

54. MUTTON AND VEAL BROTH. 

Take of either mutton, beef, or veal one pound and a 
half, cold water two quarts, rice two ounces ; simmer for 
four hours, boil for a few minutes, strain and serve. 

55. EGGS, CREAM, AND EXTRACT OF BEEF. 

Wash two ounces of the best pearl sago until the water 
poured from it is clear, then stir the sago in half a pint of 
water until it is tender and very thick ; mix with it half a 
pint of good boiling cream, and the yolks of four fresh 
eggs, and mingle the whole carefully with one quart of 
good beef tea, which should be boiling ; serve. Good in 
cases of lingering convalescence after acute diseases. 

56. BEEF TEA MADE NUTRITIOUS. 

To a pint of beef tea add bread crumbs, and boil for 
five minutes ; or mix a table spoonful of cooked oatmeal 
or rice with two of boiling water, add a cupful of strong 
beef tea and boil a few moments. Serve with toast. 

57. MUTTON BROTH. 

To a pound of meat cut in small pieces put a quart of 
cold water, boil slowly three or four hours in a closely 



326 Mother, Nurse and Infant. 

covered kettle till the meat falls to pieces ; strain, remove 
all fat, and put in two table spoonfuls of rice that has 
been soaked half an hour ; simmer until the rice is well 
cooked, season with salt, and serve with toasted cracker. 

58. BEEF TEA. 

Take lean beef, cut into shreds one pound, cold water 
one quart ; boil for thirty minutes, taking off the scum as 
it rises ; when it grows cold, strain. 

59. ESSENCE OF BEEF. 

Take of lean beef sliced, one pound ; put into a bottle 
or fruit jar, cork it loosely and place it in a pot of cold 
water (attaching the neck by means of a string to the 
handle of the vessel.) Boil for two hours and then de- 
cant the liquor and skim it. 

60. BEEF JUICE. 

Take a nice juicy steak, remove all the fat, broil it over 
a bright coal fire long enough to heat it through ; then 
with a meat or lemon squeezer press out the juice into a 
cup ; set in hot water. Remove any fat that may be in 
it ; shake the salt box slightly over it and serve. 

I shall not refer to the different alimentary preparations 
now thrown in the market, which come with printed 
directions on the packages, farther than to say that I 
have a favorable opinion of Carnrick's Soluble food for 
infants. I have tested it well. 






CHAPTER V. 



THE ART OF PRESCRIBING. 

The nurse will not often prescribe medicine, but it may- 
be of use to know how to read the prescriptions of others, 
and to know a few of the general rules or principles upon 
which physicians act in trying to produce the greatest 
curative effect with least possible inconvenience. 

THE DOSES OF MEDICINE. 

Generally in the following prescriptions the ordinary 
dose for an adult is stated. The young require a smaller 
dose than older persons, or those at maturity ; and the 
very aged cannot bear as large doses as the middle aged. 
The following is designed to exhibit the dose proportioned 
to the age ; the dose for a person of middle age being 
one drachm 

That for a 



person from 14 to 21 will be 2 scruples. 

" 7 " 14 " 

" 4 " 7 " 
of 4 years " 



\ a drachm. 
1 scruple. 
15 grains. 



3 IO 

2 o 

a a a u a 

There are some medicines however which require to be 
given to children in much larger proportioned doses than 
those stated above. For example, a child of three years 
might require half as much castor oil for a dose as an 
adult. Females usually require smaller doses than males, 



328 Mother, Nurse and Infant. 

and those of sanguine temperament than the lymphatic 
and phlegmatic. Idiosyncracies sometimes exist in indi- 
viduals rendering them peculiarly susceptible to the ac- 
tion of certain remedies, or causing a medicine to act on 
an individual in a manner wholly different from the ordi- 
nary mode. 

In general the susceptibility to the action of a medicine 
is diminished by its frequent use ; some medicines are of 
variable strength, and all these considerations should lead 
to great care in prescribing ; some medicines require more 
care than others, however, and such formula will be 
selected for insertion here as may be pretty generally used 
with safety. I believe they do not require more effort to 
adapt them to particular cases than ordinary patent 
medicines. 

MODE OF ADMINISTERING MEDICINE. 

Medicines given together should be combined with a 
definite purpose in regard to each article in the formula. 
Remedies of the same general character may be given to- 
gether in order to increase their efficacy. In F. 74 there 
are several aromatics because a small amount of each 
when combined, will be more certain in their action than 
a large amount of one kind, and at the same time they 
will be less irritating. 

The effects of one medicine are in many cases increased 
by the influence of another in augmenting the natural 
susceptibility of the system to its action. 

One medicine is given with another to counteract the 
more disagreeable effects of the more active one. 

One medicine is sometimes given as a vehicle for an- 
other ; perhaps to cover the disagreeable taste or odor 
and to render the medicine acceptable to the stomach. 



The Art of Prescribing. 329 

For example, the aromatics and ammonia in F. 74 are 
much more agreeable to the stomach than either of them 
would be separately. 

In the mixing of medicines care should be taken that 
they are neither chemically nor physiologically incompat- 
ible. When the action of an acid is desired, an alkali 
should not be given at the same time, as they unite to 
form a compound different from either. A soluble salt 
should not be given with another, or with an acid that 
would decompose it, and produce an inert compound. If 
medicines are given that have an apparent physiological 
incompatibility, it should be with a full understanding of 
their effects, and with reference to them. The form in 
which medicine is given must vary according to the nature 
of the medicine, the taste of the patient, or the condition 
of his stomach, as it is always desirable to have it so that 
it can be swallowed without difficulty. 

The physician should always write his prescription 
with neatness, order and precision, but it will be found 
an advantage to the nurse to have a ready comprehension 
of the symbols .and abbreviations used in writing pre- 
scriptions. Hence I have appended a table designed to 
explain the signs and abbreviations habitually used. Or- 
dinarily the Roman numerals are employed, and follow 
always the symbols to which they relate. A glossary 
which will include some latin terms will hereafter be 
added. 



O 

W 
ca 
»-• 
►4 
o 
53 

o 
<! 

d 

JO 

"S 

"> 
o 

.a 


Divide in equal parts 

Two. 

Let them be made. 

A gargle 

A grain or grains. 

A drop or drops. 

A draught. 

Daily. 

An infusion. 

An injection. 

1-60 of a fluid drachm 

Mix 

A mass 

A mixture. 

A pill or pills. 

Prepared. 

A powder. 

As occasion requires. 

A sufficient quantity. 

Take. 

A root. 

Write. 

A half. 

A tincture. 

Every two hours. 

Fluid oz or ounces. 


Divitur in partes 

a?qualis. 
Duo. 
Fiat. 

Gargarisma 
Granum or grame. 
Gutta or gutta?. 
Haustus. 
Indico. 
Infusum. 
Injectio. 
Minim. 
Misce. 
Massa. 
Mistura. 
Pilula or pilula?. 
Pre par at a. 
Pulvis. 
Pro re nata. 
Quantum sufficit. 
Recipe. 
Radix. 
Signatur. 
Semisis. 
Tinctura. 
Duo dis. 
Fluid uncia or uncia\ 


Div. in p.saq. 

Duo. 

Ft. 

Garg. 

Gr/ 

Gtt. or gut. 

Haust. 

Ind. 

Infus. 

Inject. 

Min. or M. 

M. 

Mass. 

Mist. 

Pil. 

ppt. 

Pulv. 

P. R N 

q. S. 

Rad. 

S. or Sig. 
ss. 

Tiuct. 
2 dis. 
f. 5 or fl. 


O 

W 

13 
t-i 

PI 


A pound or pounds. 
An ounce or ounces. 
A drachm or drachms 
A scruple or scruples 
Of each. 
Add to it. 
Until saturated. 
At pleasure. 
Alternate hours. 
Before food. 
Hot water. 
Rain water. 
Pure water. 
Tepid water. 
Twice a day. 
Let it boil. 
Let him take. 
A large spoonful. 
A tea spoonful. 
Let them be strained 
An eye water. 
Compound. 
Bruised or crushed. 
A gallon or gallons. 
A decoction. 
Let it be given 
Dilute 


pi 
« 
o 

JO 

bag 

.a 


Libra or librae 

Uncia or unciw. 

Drachma or drachma^ 

Scrupulus or scrupuli 

Ana. 

Adda. 

Ad saturandum. 

Ad libitum. 

Alternis horis. 

Ante cibum. 

Aqua fervens. 

Aqua pluvialis. 

Aqu pura. 

Aqua tepida. 

Bis die. 

Bulliat. 

Copiat. 

Cochlear magmum. 

Cochlear parvum. 

Colentur. 

Collyrium. 

Compositus. 

Contusus. 

Congius or Cpngii. 

Decoctum. 

Detur. 

Dilutus. 


»-3T3 r d'^ c ^co" 1 cr.^S 3 oT o oc'c c c c j^ <i> ^ 



Classification of Remedies. 331 

The succeeding chapter is composed of formulae giving 
numerous examples of the different forms in which pre- 
scriptions are written. Good taste requires that all direc- 
tions should be in the English language, and that hiero- 
glyphics and absurd abbreviations should be discarded as 
much as possible. Very many physicians write the direc- 
tions in latin, and the druggist is expected to write the 
same in English and attach a label thus written to the 
bottle containing the medicine. I have given some ex- 
amples of the old-form prescriptions written entirely in 
latin, and also some where the new notation (figures, &c.) 
is used. Whoever reads them over will learn how to read 
prescriptions ; but I have given none but such as I value 
highly, and I have used almost every one in my practice, 
and tested its excellence. I advise people to obtain these 
rather than those patent medicines whose composition is 
secret. The person who desires one of these prescribed 
medicines can obtain it by copying the formula accurately 
and taking it to a druggist. I adopt the usual 

CLASSIFICATION OF REMEDIES. 

Antacids neutralize acids existing in the alimentary 
canal, or circulating with the blood ; antiseptics coun- 
teract putrefaction ; antispasmodics relax spasm and 
calm nervous irritation ; astringents cause vital con- 
traction of the organic textures ; anthelmintics destroy 
worms, or expel them from the bowels ; cathartics act 
on the bowels, producing a purgative effect ; caustics 
destroy the life of the part upon which they act ; diapho- 
retics increase the cutaneous discharge ; diuretics 
produce an increased flow of urine ; emetics produce 
vomiting ; expectorants augment the secretion from 
the pulmonary mucous membrane ; enemata cause 



332 Mother, Nurse and Infant. 

evacuations from the rectum, &c; emmenagogues ex- 
cite the menstrual secretion ; narcotics affect the cere- 
bral functions ; tonics exalt the energies of the whole 
system. I shall give examples of remedies which are de- 
signed to produce these several effects, besides some be- 
longing to other classes. 

Where the word teaspoon is used it signifies one hold- 
ing about 55 drops of water = 3 j. (one drachm); i 
table spoon about half an ounce, and this is written 3 ss ; 
one wineglass equals two ounces, written 3 ij ; one teacup 
equals four ounces, written 3 jv.; one coffee cup equals 
eight ounces, and is written 3 viij. 

The gramme of the French metric system equals 
about 15 grains, and this is the unit of weights. The 
system is of the decimal character and the latin prefixes 
deci, centi, milli, &c, are used to indicate its subdivisions, 
and the Greek deca, hecto, kilo, myria, &c, are its multi- 
ples, always on the scale of ten. 

.001 gramme = 1 milligramme. 
.01 gramme = 1 centigramme. 
. 1 gramme = 1 decigramme. 
1 gramme 

10 gramme = 1 decagramme. 

100 gramme = 1 hectogramme. 

1000 gramme = 1 kilogramme. 

Physicians, many of them, prefer to employ latin names 
to designate the ingredients of their prescriptions, and to 
write the directions to the druggist in latin. I will first 
give a few latin prescriptions with the translation. 



CHAPTER XII. 

MEDICAL FORMULARY. 

Formula 61. Fiat haustus. (Let a draught be made.) 

I? Magnesias sulphatis drachmas duas. 

Inf usi senna? fluidunciam. 

Syrupi rhei fluidrachmam. 

Misce et fiat haustus, in jusculo calido, parti tis vicibus sumen- 
dus. 

The above prescription translated into English would 
read : 

Take of sulphate of magnesia two drachms. 

Infusion of senna one fluid ounce. 

Syrup of rhubarb one fluid drachm. 

Mix and let a draught be made to be taken in divided doses in 
warm broth. 

The following is a convenient form and one not liable 
to mistakes : 

I? Magnesia? sulph 3 ij. 

Syr. rhei f 3 j. 

Inf us. senna? — f § j. M., et fiat haustus. 

S. To be taken in divided doses in warm broth. 

62. FOR COLIC 

1? Magnes. alb. ust 3 j. 

Tinct. foetid gtt. lx. 

' ' theb gtt. xx. 

Aq- ^nt |j. 

Translation. 

Take Calcined magnesia 20 grains. 

Tincture of assafoetida 60 drops. 

Laudanum 20 drops. 

Water 1 ounce. Mix. 

S. Dose. 20 drops for a child, in sweetened water. 

333 



334 Mother, Nurse and Infant. 

63. for cholera infantum and dysentery. 

]? Sal tart, vel carb. sod gr. xxx. 

Grum Arabic : 

Sacch. Alb aa. 3 j. 

Tinct. theb gtt x. 

Aq. Font g ii j . 

Translation. 

Take salt of tartar or soda > 20 grains. 

Gum Arabic and loaf sugar each 1 drachm. 

Tincture of opium (laudanum) 10 drops. 

Water 3 ounces. 

To the above a drop of oil of cinnamon may be added 
and it may be given in doses of one teaspoonful in lime 
water and milk, when cholera morbus is followed by 
diarrhoea and dysentery. 

64. FOR croup, &c. 

5 Tr. phytolac dec gtt. vj . 

Tr. aconit gtt. iij. 

Aqua ... I iv. m. 

Translation. 

Take Tinct. of poke root 6 dr<>ps. 

Tinct. of aconite 3 drops. 

Water 4 ounces. Mix. 

Dose a teaspoonful every five or thirty minutes, as is necessary. 

For a case of mammary abscess it may be given inter- 
nally, and also rubbed upon the breast in the forming 
stage. 

65. FOR CHRONIC ENLARGEMENT OF THE SPLEEN. 

Errata. On page 44, for 12, 18, 23, 52, 54, 57, 61, 62, 65, read 10, 16, 18, 19, 20, 23, 
25, 28. On page 43, last line, for 65 read 58. 

5 Tinct. cinch, cornp 3 viij. 

Aq. menth. pip J xij. 

Ammon. murias 5 j. M. 

Translation. 

Take of Compound tincture of Peruvian bark. .8 ounces. 

Peppermint water 12 ounces. 

Muriate of ammonia 1 ounce. Mix 






Formula, 335 

S. Dose one teaspoon ful three times a day, one hour before 
meals. 

66. CHRONIC RHEUMATISM. 

1} Pulveris guaiaci resin a 4 , 

Potassa* nicratas aa. Z j. 

Pulveris ipecacuanha' gr. iij. 

Opii gr. ij. 

Fiat pulvis in charletas sex dividendus. 

Translation. 

Pulverized gum guiac, 

Nitrate of potash of each 1 drachm. 

Powdered ipecac 3 grains. 

Opium 2 grains. Mix. 

Divide into six powders. 

S. One powder to be taken every three hours in syrup or mo- 
lasses. 

67. FOR SCIATICA AND FOR THE KIDNEYS. 

1? 01. cubeba, 

01. copaiba aa. f . 3 jv. 

01. tenebinth f. 3 ij. 

Spts. nit. a?th f. 3 vj. 

Mucilagio acacia ... f. ? ij. M. 

Translation. 

Take oil of cubebs, 

Oil of copaiva of each four fluidrachms. 

Oil of turpentine two fluidrachms. 

Spirits of nitric ether ..... .six fluidrachms. 

Mucilage of gum Arabic two fluid ounces. Mix. 

Mark. One teaspoonful three times a day. 

68. FOR GASTRIC ULCER. 

Ij Morphine sulphatis gr. j. 

Bismuth subnitratis : ss. M. S. Ft. Chart. No. vj. 

Translation. 

Take morphine 1 grain. 

Sub nitrate of bismuth \ drachm. Mix. 

Make six powders. Mark. One powder to be taken every four 
hours. 



336 Mother, Nurse and Infant. 

antacids. 

69. carbonate of magnesia. 

I? Magnesia carbonatis grs. 80. 

Extracti opii liquidi min. 30. 

Spiritus etheris fl . drs. 3. 

Aqua mentha viridis. . . . . adfl. oz. 6. Mix. 

One fourth part occasionally. Useful where there is much op- 
pression from flatulency. 

70. CHALK MIXTURE AND HOPS. 

12 Tincture lupuli 3 vj . 

Tinct, cardamomi compositae fl. 3 jv. 

Vini ipecacuanha? fl. 3 ij- 

Extractii opii liquidi min. xxx. 

Mistura creta ad. fl. 5 vj. M. 

Translation. 

Take tincture of hops 6 drachms. 

Compound tinct of cardamom. . . .4 fluidrachms. 

Wine of ipecac 2 fluidrachms. 

Liquid extract of opium 25 minims. 

Chalk mixture (add to it) 6 fluid ounces. Mix. 

Mark. One teaspoonful every three or four hours. Useful in 
diarrhoea due to acidity in the stomach. 

7T. FOR HEARTBURN. 

1* Liquor magnes. carb § ss. 

Sp. lav. comp 3 ij- M. Ft. haust. 

Translation. 

Take liquor of carbonate of magnesia \ ounce. 

Compound spirits of lavender 2 drachm. 

Make a draught. Take immediately and repeat if necessary. 

72 FOR ACIDITY OF THE STOMACH. 

1? Pepsin 5 grains. 

Sub nitrate bismuth 5 grains. 

Glycerine i ounce. M. 

Sig. After each meal 



Formulae. 337 

73. for infantile colic. 

1$ Magnesia carb 3 ij. 

Tinct assafoetida min. xx. 

Aqua §ij. M. 

Sig. Thirty drops and repeat every half hour until relieved. 

74. FOR DISORDERED STOMACH. 

Ij Aqua ammonia 3 ij. 

Essence cinnamon 

Tinct ginger aa. % ss. 

Tinct. pimento | j. 

Alcohol § ij. 

Water 5 viij . Mix. 

Of this one teaspoonful may be put in a glass of water, of 
which the patient may take a teaspoonful every hour. 

75. NAUSEA AND VOMITING. 

No. 1. 1? Bicarb, potass grs. xxx. 

Water f. I ij. 

Bromide potass grs. xxx. M, 

No. 2. I? Citric acid 3j. 

Water § jv. 

Syrup f . 3 x. M. 

Add a table spoonful of No. 2 to a teaspoonful of No. 1 and 
drink immediately. 

76. A POWDER FOR HEARTBURN. 

E Magnesia calcinatae 5 | ss. 

Bicarbonate sodae 

Pulveris zinziberis aa. B j . M. 

Sig. A small teaspoonful occasionally. 

77. CHALK MIXTURE. 

5 Prepared chalk 3 jss. to 3 ij. 

White sugar 

Pulv. gum Arabic aa. q. s. 

Peppermint water § vj. M. 

Sig. A table spoonful for a dose every two hours. When ad- 
ministered for diarrhoea, astringents and laudanum may be added. 

78. CHOLERA MIXTURE. 

I? Chalk mixture 3 j. 

Spirits chloroform xx. 

Tinct. opium min. jv. M. 

To be taken every four hours. 



338 Mother, Nurse and Infant. 

79. neutralizing cordial. 

I? Bicarbonate of potash 

Pulv. rhei aa. 3 ij. Mix and add of 

Boiling water f. § viij. 

Let it stand for two hours, filter and add 

Brandy f. Jj. 

Essence peppermint f. § j. 

Add white sugar to an agreeable sweetness. 

Highly useful in diarrhoea, dysentery, summer com- 
plaint, &c, especially of children. 

80. FOR DIARRHCEA AND DYSENTERY. 

1) Oil cinnamon 
Oil cloves 

Extract ginger aa. § ss. 

Morphine grs. ij. 

Rhubarb grs. xx. 

Aqua ammonia 3 i j . 

Spirits camphor 3 ij . 

Alcohol § viij . 

Water |iv. M. 

S. Dose, i teaspoonful every two hours, in water. 

81. SODA MINT FOR NAUSEA, &C 

^ Soda* bicarbonas 3 j. 

Aqua Menth. pip § xvj. 

Spirits ammon. arom 3 ss. M. 

Dose. 1 table spoonful. 

82. FOR FLATULENT DYSPEPSIA. 

ty Salacylate of bismuth 2 parts. 

Calcined magnesia 3 parts. 

Oil of anise 1 part. M. 

Of this powder a small teaspoonful may be taken before a meal. 

ANTISEPTICS. 

83. LAVENDER AND CAMPHOR. 

JJ Spirits of camphor . . min. xx. 

Spirits of lavender f. 3 j. 

Gum trugacanth mucilage , . .f. 3 vij. 

Make a draught. To be taken every six or eight hours by a 
nervous attendant in a sick room. 






Formu i i 339 

84. SOLUTION OF CHLORINATED SODA. 

ljl. Liquoris chlorinate 3 j. 

Tinct. opii min. xv. 

Camphone aquae i. I xij. M. 

A table spoonful three times a day relieves the fetor, and is 
otherwise useful in low cases of fever, gangrene of the lungs, &c. 

ANTISPASMODICS. 

85. AMMONIA MIXTURE. 

1? Aromatic spirits of ammonia fl. 3 j. 

Dilute hydrocyanic acid min. ij. 

Syrup ginger min. f . 3 j. 

Caraway water fl . 3 vij . 

Make a draught. To be taken twice or three times a day if 
there be flatulence or languor. In dyspepsia, debility, irritable 
stomach, &c. 

86. FOR ASTHMA. 

5 Tinct-. lobelia § j. 

Ammon. iodide, 

Ammon. bromide aa. 3 ij. 

Syrup tolu § iij. M. 

Sig. A table spoonful every one, two, three, or four hours. 

87. FOR WHOOPING COUGH. 

fy Aluminis 3ijss. 

Syrup zinzib g j. 

Syrup acacias § j. 

Aqua I j. M. 

Sig. One teaspoonful three times a day. 

88. FOR ASTHMA. 

I£ Ext. Jamaica dogwood fl. ? ij. 

Syrup ipecac fl. 3 j . 

Syrup aurant. cortex 3 ss. M. 

Sig. A teaspoonful every hour until the paroxysm should 
cease. Afterwards every four hours for the day. 

89. ASIATIC MIXTURE FOR CHOLERA. 

5 Gum opii, 

" camph aa. J j. 

01. caryoph f. 5 j. 

Capsicum (cayenne) 3 j. 

Sp. a?th. sulph. Co Oij. Digest 15 days. 

Dose for an adult, 20 to 60 drops every 2, 3, or 4 hours. 



340 Mother, Nurse and Infant. 

90. for dysmenorrhcea. 

,1? Tinct. gelsemium, 
Tinct. camphor, 

Tinct. opii deodorized aa. 3 ij . M. 

S. Dose 20 drops every two hours until relieved. Useful in 
dysentery after the operation of Epsom salts. 

91. Hoffman's anodyne and laudanum. 

^ Liquoris anodyne Hoffman's 3 iij. 

Tincturae thebiacae gtt lxxx. 

Aqua cinnamomi 1 vj. 

Fiat Mistura. Signa, A teaspoonful every hour in hysteria, 
&c. May sometimes be taken in a dose of a table spoonful. 

92. FOR AFTER PAINS. 

3 Morphia sulphas gr. j. 

Pulv. camphora?, 
Creta preparata, 

Pulv. glycerhiza aa. 3 j. M. 

Given in 10 grain doses and repeated, when required, every 4 
hours. 

ASTRINGENTS. 
93. FOR DYSENTERY. 

ty Acidi tanici gr . xxx. 

Tinct. camphoraa comp f . I j. 

Aqua cinnamomi ad. f . 3 viij. M. 

Label. One sixth part three times a day, about an hour before 
each meal. 

94. CINNAMON MIXTURE. 

5 Tinct. cinnamon f . 3 ij. 

Cinnamon water f . ? j. M. 

Make a draught to be taken thrice daily. In menorrhagia es- 
pecially, but also in other varieties of passive hemorrhage. 

95. CHLOROFORM, OPIUM, AND CASTOR OIL. 

1^ Chloroform min. x. 

Tinct. camph. comp f . 3 ij. 

Castor oii. . f . 3 iij. 

Make a draught to be taken immediately. In choleraic diar- 
rhoea. 



Formulae. 341 

96. for hemorrhage of the urethra, &c. 

1$ Tinct. ergot, 

Oil of turpentine aa. f . 3 ij. 

Tinct. chloride of iron, 

Laudanum aa. f . 3 j . 

Gum Arabic mucilage f. 5 viij- M. 

Sig. Take one table spoonful hourly. 

97. IN HEMOPLYSIS (BLEEDING FROM THE LUNGS.) 

1} Fid. ext. ergot, 
Paregoric, 

Syrup tolu equal parts. M. 
S. Half a table spoonful every hour if necessary. 

98. FOR PHTHISIS WHEN NIGHT SWEATS AND COUGH 

ARE BAD. 

1? Acidi sulphurici diluti gtt, x. 

Tinctunc opii deodorata? gtt. x. 

Syrupi hypophosphatis f. 3 j« 

Extract! Pruni Virginiani fluidi f. 3 ij- M. 

For a dose ter. die. 

It will be more convenient to have the above put up 
according to the following form : 

3 Elixir vitriol 3 iij. 

Deodorized laudanum 3 jss. 

Syrup hypophosphitis f . 3 xv. 

Fid. ext. wild cherry f . 3 xxx. M. 

Sig. Take nearly a table spoonful three times a day. (For an 
adult.) 

99. FOR INFANTILE DIARRHCEA. 

Ij Sub. nitrate bismuth 3 ij. 

Laudanum min. ij. 

Gum Arabic mucilage . . 3 jv. Mix. 

S. A teaspoonful every two hours. 

IOO. FOR CHOLERA MORBUS. 

Ij Spirits am. arom 3 j. 

Spirits lav. co 3 j. 

Tinct. opii camph 3 ss. Mix. 

S. A teaspoonful in water every two hours or oftener, until 
relieved. In cholera morbus, colic, dysentery, &c. 



34 2 Mother, Nurse and Infant. 

ioi. for cholera infantum. 

I? Bismuthi sub carbonatis gr.xvj. 

Pulv. ipecacuanha comp gr. j. 

Pulv. sacchari albi grs. xij. Mix. 

For viij powders. One to be taken every three hours in the 
mother's or cow's milk. 

102. FOR CHRONIC DYSENTERY. 

I? Soda? bicarbonas. 3 ss. 

Zinci oxide 3 ij. M. 

Sig. 6 grains every six hours. 

103. FOR PROLAPSIS UTERI. 

B Fid. ext. mix vomica f . 3 j . 

Fid. ext. blue cohash f. 3 ss. 

Fid. ext. ergot 3 ij. 

Simple syrup 3 ij. 

Chloroform min. x. M. 

S. One-half a teaspoonful three times a day. 

104. ASTRINGENT POWDER. 

B Sub. nitrate of bismuth grs. xij. 

Pulv. geranium root grs. jx. 

Dover powder gr- j- M. 

Divide into six powders. Give one powder every six hours. 
CATHARTICS. 
105. THE WHITE MIXTURE FOR RHEUMATISM. 

B Epsom salts 3 jss . 

Carbonate magnesia 3 ij. 

Peppermint water f . 3 viij. 

Wine of colchicum f. 3 ij. M. 

One-sixth part early every morning. 

106. FOR DYSENTERY. 

I? Syrup of rhubarb f. 3 ij. 

Syrup of ginger f. fiij. 

Tincture of opium f. 3 j. 

Oil of cloves gtt. xxx. M. 

S. One teaspoonful every two or three hours. 






Formul/E. 343 

107. for vomiting of pregnancy, 

l» Rad. qolumbo (col umbo root), 

Kad. ginger (ginger root), aa. 3 ss. 

Fol. senna (senna leaves) 3 j. 

Boiling water Oj. 

Sig. Wineglassful before meals. 

108. COMPOUND LICORICE POWDER. 

\i Powdered senna leaves, 

" licorice root aa. 3 vj, 

" fennel seed, 

4 ' sulphur aa. § ii j . 

" sugar 5^vj. M. 

Dose one teaspoonful as a mild laxative. 

IO9. AS A LAXATIVE FOR ANTIPARTEM ADMINISTRATION. 

3 Senna leaves 3 ii j - 

Sulphate of magnesia 3 xx. 

Bruised ginger | x. 

Boiling water cong. j . 

Let the mixture stand over night ; filter. Dose, two or three 
ounces. 

IIO. FOR PILES. 

1? Magnesia sulp., 
Magnesia carb., 
Sup. tart, potass., 
Sulphur sublim aa. 3 j. Mix thoroughly. 

Sig. One, two, or three teaspoonfuls of the powder before eat- 
ing in the morning. 

III. FOR DYSENTERY. 

B Mucilaginis tragacantha? fl 3 ij. 

Aqua cinnaraomi fl. | iij. 

Olei ricini fl. I xij. 

Tinct. rhei , 

Syrup aurantii aa. fl. I vj 

Tinct. opii min. xxx. Mix. 

S. One-eighth part for an adult every three hours. In dysen- 
tery where there are scybala in the rectum. Also where an 
aperient with a sedative is needed. 



344 Mother, Nurse and Infant. 

anthelmintics. 

112. to expel the round worms. 

I? Santonin gr. 3. 

Sacchari lactis gr. 10. 

Make a powder to be taken early in the morning in a table 
spoonful of milk or cream. Its exhibition should be followed at 
the end of six hours by mild physic. 

113. FOR TAPE WORMS. 

I? Oil of turpentine 4 drachms. 

Gruel (not too thick) 3 ounces. Mix well. 

Abstain from supper ; take a mixture on waking in the morn- 
ing, and lie down until it operates. 

114. FOR WORMS. 

I? Santonin 16 grs. 

Flu. ext. spigelia 16 drops. 

Simple syrup 2 ounces. Mix. 

Sig. Teaspoonf ul morning and night. 

CAUSTICS AND RUBEFACIENTS. 

115. CHROMIC ACID. 

B Acidi chromici grs. 60. 

Aqua : fl. drs. 4. M. 

Apply directly to warts, &c, to destroy them. 

116. IODINE PAINT. 

5 lodini grs. xl. 

Potassai iodidi 3 ss 

Spirits vini rectificati f . 1 j. M. 

To be applied with a camel's hair brush. 

117. BURNT ALUM. 
The alumen ustem is made by depriving the alum of its water 
of chrystalization by heat. It is applied in powder to fungous 
granulations of ulcers, and mixed with sugar is used to remove 
nebulous spots on the cornea. 

Il8. FOR PRICKLEY HEAT. 

I? Sulphate of copper grs. xx. 

Water , 3 ij. M. 



Formula. 345 

Apply daily by means of a camel's hair brush or a sponge. It 
is applied after a morning bath, after the skin has been well 
rubbed with a towel, and it must be allowed to dry on the skin 
before dressing. 

DIAPHORETICS. 
TI9. A PLEASANT DIAPHORETIC IN FEVERS. 

I? Citratis potasae preparata? I ij. 

Aqua distilata 1 3 jv. to § vi. 

Olei limonis gtt. ij. 

Sacchari alba 3 j. Misce. 

S. A table spoonful to be taken every two hours. Spirits of 
nitre may be added. 

I20. INFUSION OF BONESET. 

R Eupatorii perfoliati 3 j. 

Aqua bulientis Oj. 

Infuse for thirty minutes in a covered vessel ; then decant and 
take a wineglassful every hour till there is free perspiration. The 
infusion must be taken hot as it can be drunk, otherwise it may 
produce vomiting. 

121. DECOCTION OF BARLEY WATER WITH NITRE. 

5 Decocti hardei Oj. 

Nitratis potassre . , 3 ij. 

Succi limonis % j. to § ij. Fiat potus. 

Translation. 

Take barley water one pint. 

Salt petre , two drachms. 

Lemon juice one ounce to two ounces. 

Make a drink to be drank warm by the patient. 

122. MODIFIED DIAPHORETIC. 
Errata. On page 172 for (F. 122) read (F. 108.) 

Ij Opii pulv 3 j. 

Ipecac pulv 3 ss. 

Camphor pulv 3 ij. 

Saccharum 3 iv. Mix thoroughly. 

This and the following prescriptions in doses of from 

two to eight grains may be used as a 



34 6 Mother, Nurse and Infant. 

123. substitute for dover powders. 

^ Morph. sulph 3 j. 

Camphorae, 
Oreta prep., 
Saccharum aa. 3 xx. 

124. DIAPHORETIC AND EXPECTORANT. 

5 Potass citrat 3 j. 

Sue. limonis f . § jss. 

Syr. ipecac f . 3 ss. 

Tr. opii camph f . 3 iij. 

Syrupi q. s. ad. f. 3 iij. M. 

S. Dessert spoonful every two hours. For colds and coughs. 

DIURETICS. 
125. NITRE, JUNIPER, AND ETHER. 

5 Potassa nitratis grs. 60. 

Spiritus juniperi f. dr. 1. 

Spiritus oetheris nitrici f . dr. 3. 

Decocti chimaphila? ad. f . oz. 8. Mix. 

One-sixth part every six hours. 

126. DIURETIC AND LAXATIVE. 

5 Potassa? tartratis 3 iij- 

Infus. buchu f . § viij. Mix. 

S. One-sixth part three times a day. 

127. FOR CYSTITS IRRITABLE CONDITION OF THE 

BLADDER. 

^ Acidi benzoici, 

Sodii biboratis aa. gr. x. 

Inf. buchu , I ij. M. 

Sig. This amount three times a day. 

128. INFUSION OF UVA URSI. 

5 Uva ursi foliorum 3 j. 

Aqua bulientis Oj. 

Pour the water boiling hot on the leaves and let them macerate 
for several hours. To be taken cold, from half a pint to a pint 
daily. Chiefly used for irritable bladder and strangury. 



Prescriptions. 347 

129. for subacute and chronic rheumatism. 

U Potass iod 3 ij. 

Vin. calc. rad f. 3 ij- 

Tinct. guiac ammon f. 5 ii j - 

Fid. ext. belladonna min. xx. 

Aqua cinnamon 5 iij. M. 

A teaspoonful in water three times a day. 

130. FOR MUSCULAR RHEUMATISM. 

I? Potasii iodide 3 j. 

Vini colchici rad f . 3 ij- 

Morphia sulphatis gr. iij. 

Syrupi f. I j. 

Aquae f . 5 iij- M. 

S. A teaspoonful three times a day. 

131. FOR DROPSY. 

5 Fid. ext apocynum Canabinum 3 ij. 

Spts. lav. comp 3 ss. 

Syrup simplex 3 iij ss. M. 

S. A teaspoonful every three or four hours. 

132. FOR URETHRAITIS. 

3 Tinct. gelsemii ' 3 ss 

Potassii bromidi 3 ijss. 

Potass, bicarb 1 ss. 

Aqua 1 iv. M. 

S. Dessert spoonful in water three times a day. 

EMETICS. 
133. POWDER OF IPECAC. 

5 Pulvis ipecacuanha 2>ij. Divide into two doses. 

Signa. One to be taken in a little sweetened water or warm 
water. If one powder does not produce the desired effect within 
thirty or forty minutes, the second to be taken in like manner. 
It may be followed by a draught of tepid water after vomiting 
commences. 

134. POWDER OF SULPHATE OF ZINC. 

3 Sulphate of zinc 10 grs. to 3 ss. 

Signa. To be taken in syrup, and followed by a draught of 
warm water. 



348 Mother, Nurse and Infant. 

135. emetic for a child. 

5 Very young children in some instances suffer from indi- 
gestion. If delicate give five grains ipecacuanha, and after that 
sickens the child give a dose of castor oil to remove the offending 
matter from the stomach. 

136. EMETIC USED IN CAPILLARY BRONCHITIS OF 
CHILDREN. 

5 Zinchi sulphatis gr. iij. 

Pulveris ipecacuauha gr. ij. M. 

For one dose ) to be repeated every ten minutes until emesis is 

produced. 

EXPECTORANTS. 

137. SEDATIVE COUGH MIXTURE. 

5 Vinum ipecacacuanha fl dr. li. 

Spiritus etheris nitrosa fl. dr. 6. 

Infusi senega ad. fl. oz. 8. Mix. 

One-sixth part every six hours. In chronic bronchitis when an 
expectorant and sedative is desired. 

138. INFUSION OF FLAXSEED, &C. 

3 Seminum lini § j. 

Radicis glycerhiza 5 ss. 

Aqua bulientis Oij . 

Macerate for two or three hours near the fire in a covered vessel, 
strain, and add lemon juice sufficient to make it agreeable. This 
may be given as a common drink in catarrh. 

139. COUGH SYRUP. 

Errata. On page 123, for 139, 140, read 81, 107. 

3 Morphine grs. viij. 

Fid. ext. ipecac f . 3 jss. 

Tinct. bloodroot f . § j. 

Water | vj. 

Simple syrup f . 3 xxv. 

Chlorate potash ; § ss. 

Muriate of ammonia 3 j. M. 

S. Dose for an adult, a teaspoonful three times a day and 
after each fit of coughing. 



Prescriptions. 349 

140. tar water. 

Ij Picis liquida Oij. 

Aqua Cong, j . M. 

Stir them together with a wooden rod for ten minutes, then let 
the tar subside. Strain the water and keep in well corked bottles. 
A pint may be taken daily. 

141. FOR WHOOPING COUGH. 

1£ Ammon. bromide 3 j. 

Tinct. strammonii, sem gtt. xx. 

Syrup simplex \ ij. 

Aqua 1 ij, M. 

Sig. A teaspoonful three times a day for a child. 

142. FOR PNEUMONIA. 

Vf. Syrup senega 1 ss. 

Spirits nitre, 

Tinct. digitalis aa, f. 3 ij. 

Morphine gr. ij. 

Simple syrup f. § ij, M. 

Sig. Dose, a half teaspoonful every three hours or oftener. 

143. PNEUMONIA. 

^ Tinct, aconite , gtt. xxx. 

Fid. ext. jaborandi, 

Spirits nitre dulcis aa. 5 ij. 

Aqua I jv. M. 

Sig. A teaspoonful every four hours for an adult. 

144. FOR COUGH. 

1$ Syrup wild cherry § ii j . 

Tinct. sanguinaria 3 j. 

Morphine grs. ij . 

Chlorate potash grs. xv. 

Muriate of ammonia grs. x. 

Aqua Ij. M. 

Sig. Dose, \ a teaspoonful every six hours, and after each 
spell of coughing. 

ENEMATA AND INJECTIONS. 

145. FOR ASCARIDES. 

ty Sulphuric ether 5 to 20 drops. 

Water \ pint to a pint. M. 

Inject into the bowels. 



350 Mother, Nurse and Infant. 

146. injection for ascarides or pinworms. 

g Acid carbolici 3 j 

Potassa chloratis 3 i j . 

Aqua Oj. M. 

Warm to 98 ° and inject into the bowels. 

147. INJECTION FOR THE VAGINA. (THIS MAY BE USED 
DILUTED WITH WATER.) 

1* Tannin 3 j. 

Zinci sulphatis 3 ij 

Aqua tepidi Oj. M. 

Inject with a Davidson or a fountain syringe. 

148. ENEMA FOR PINWOKMS. 

I? Argenti nitratis (nitrate silver) cryst. . .8 grs. 

Aqua distilat 6 oz. for an enema. 

Repeat this each day for four or five days. This will stain 
clothing. 

149. ENEMA TO MOVE THE BOWELS. 

5 01. ricini (castor oil) f. ? ij. 

01 terebinth, (spirits turpentine) f . 3 i. 

Aqua fervent Oij. 

To be administered at once. 

150. FOR ACARIDES CAUSING VAGINAL DISCHARGE. 

I? Tinct. ferri chloridi 3 ss. 

Aqua calcis Oj. Ft. injectio. 

Inject one-half into the rectum at night and the other half the 
next morning. 

151. EMMENAGOGUE ENEMA. 

1£ Aloes barbadensis gr. x. 

Tepid milk f . = M. 

To be injected twice a day when the menstrual flow is due, for 
one or two days. 

152. FOR IRRITABLE UTERUS. 

1^ Bromide potash 3 j . 

■ Water Oj. M. 

Use as a rectal injection. Where there is pain in the part, one 
drachm of the tincture of opium hyoscyamus or conium may be 
used in the same way. 



Prescriptions. 351 

153. VAGINAL INJECTIONS. 
Errata. On page 83 for (F. 153, 199) read (163, 214.) 

The vaginal injections most used when disinfection is 
the special object, and the usual proportions are the fol- 
lowing : 

3 Corrosive sublimate, 1 to 1000 or 2000 ; carbolic acid, 5 
or 10 to 1000 ; thymal, 1 to 1000 ; sulphite of soda, 5 to 1000 ; 
permangenate of potash, 5 to 1000 ; liquor sodii chlorinate 
(Labaraques solution), 1 to 2; chlorine water, 1 to 2 ; salacylic 
acid, 1 to 1000 hot water. 

For medicinal astringent vaginal injections, give alum, sulphate 
of zinc, or lead, copper, and iron, salts of the strength of one or 
two per cent. 

The permangenate of potash, silver nitrate, and iron 
solutions all make almost indelible stains on the linen. 

If the injections are corrosive, a large straight glass 
syringe should be used. 

154. INJECTION FOR LEUCORRHCEA. 

g. Alum, 

Sulphate of zinc, 
Borate of soda, 

Pure carbolic acid aa. § jss. 

Water Oij. M. 

Of this two table spoonfuls in a pint of water. 

155. VAGINAL INJECTION. 

$ Zinoi sulphatiz, 

Aluminis exsiccata aa. § j. 

Acidi tannici | ij. Mix. Label. 

Half a teaspoonful to be mixed with a pint of tepid or cold 
water to form an injection. 

156. INJECTION FOR DYSENTERY. 

I£ Mucilage of gum Arabic or starch 3 ij. 

Laudanum gtt. xx. M. 

For an injection. 

157. INJECTION FOR FETID LEUCORRHCEA. 

1^ Chlorate of potash 3 j. 

Laudanum f . 3 j. 

Tar water Oij. M. 



352 Mother, Nurse and Infant. 

S. Three table spoonfuls to be added to the pint of warm 
water as a vaginal injection. 

EMMENAGOGUES UTERINE THERAPEUTICS. 

158. STIMULANT EMMENAGOGUE. 

I? Potassa bromide 3 j. 

Tinct, cantharides . f . 3 jss. 

Tinct. cinnamomi f . 3 j v. 

Aqua q. s ad. f. 5 jss. M. 

S. Teaspoonful three times a day for amenorrhoea and hysteria. 

159. FOR CHLOROSIS. 

^ Tinct. ferri per chloridi f. 3 jss. 

Potassa chloratis 3 jss. 

Tinct. actca racemosa f. 3 jv. 

Infusi serpentaria ad. f . ? M. 

Sig. One-eighth part three times a day. 

160. RECTAL SUPPOSITARY. 

B Ext. opii aq 3 grains. 

Ext. belladonna . . . . 1£ grains. 

Buteri cacao. . . q. s. 1£ ounces. M. ft. suppos. No. 12. 
S. Apply one to relieve pain in the region of the uterus or 
rectum. 

l6l. FOR PAINFUL MENSTRUATION. 

5 Ferri carbonate pulv 3 iij. 

Ext. conii mac 3 ijss. 

01. cinnamom min. xx. 

Syrup tolutani % ij. 

Syrup simplici, 

Aqua aa. 3 vij. M. 

S. Dose, a table spoonful four times a day. To be given for a 
week or ten days before the menstrual period. 

162. FOMENTATION FOR PAIN IN THE BLADDER AND 

UTERUS. 

Errata. On page 90 for (F. 162) read (F. 163.) 

Ij Flores chamomela? 8 ounces 

Pulv. semen lini 3 ounces. 

Herb hyscyami, 
Herb belladoni, 
Herb strammonii aa. 1 ounce. M. 



Prescriptions. 353 

Sig. Make fomentations. To bo applied topically and covered 
witli oiled silk to retain heat and moisture. 

163. VAGINAL SUPPOSITARY. 

Q Zinci oxide vel bismuth carbonatis 3 jss. 

Extracti belladonna 4 3 ss. 

Olei theobroma J j. 

Olei olivae 3 i j . M . 

Divide into eight pessaries. Used in chronic leucorrhoea, vagin- 
itis, &c. 

NARCOTICS AND SEDATIVES. 
164. FOR HEADACHE. 

^ Morphia? sulphatis. .gr. ss. 

Sodii bromidi gr. xj. M. et fiant. charlutas No. ij. 

Sig. Take one powder dissolved in a wineglass of water, to be 
repeated in an hour if necessary. 

165. FOR SUBACUTE RHEUMATISM. 

$ Vinum colchici rad f. § j. 

Morphia sulph gr- v. 

Magnesia sulph . § j. 

Potassa iod 3 iv. 

Aquae f . 5 iij. M. 

Sig. Half a teaspoonful in water. 

l66. EPILEPTICAL SEIZURES AT THE MENSTRUAL PERIOD. 

f£ Potassa bromide grs. xx. 

Tinct. belladonna min. ij. 

Syrup, 

Aqua q. s. ad. ft. 3 jv. M. 

S. One dose three times a day. 

167. OVARIAN NEURALGIA. 

I? A mmon murias 3 ij . 

Tinct. aconit 3 j. 

Syrup aurant. cort ? xij. M. 

S. One teaspoonful three times a day. 



354 Mother, Nurse and Infant. 

l68. soothing nervine and tonic. 

3. Pot bromide • 1 ss 

Ferri pyrophos | j. 

Elixir humuli, 

Aquae aa. § jv. M. 

Sig. Table spoonful three times a day. 

169. FOR HEADACHE. 

§. Ammonia murias 3 iij. 

Morphia acetat gr. j. 

Caffeine citrat 3 ss. 

Spts. ammon. aromat 3 j. 

Elixir guarana, 

Aqua rosae . . aa. § jv. M. 

Sig. Dessert spoonful every ten or twenty minutes. 

170. TOOTHACHE DROPS. 

12 Chloroform 14 parts. 

Mastich 8 parts. 

Bals. Peru 5 parts. M. ft. sol. 

Sig. Place two or three drops in cavity of tooth. 

171. FOR FUNCTIONAL PALPITATION. 

^ Tr. digitalis 3 v. 

Tr. veratrum 3 ij. 

Tr. aconite 3 j. 

Tr. ginger 3 ijss. M. 

S. One teaspoonful three times a day. 

172. STIMULANT EMMENAGOGUES. 

3. Ferri phosphatis 3 ij. 

Manganesii phosphatis gr. xxx. 

Tincturaa columbae fl. § j. 

Syrupi zinziberas fl- I ij- M. 

S. One teaspoonful in a wineglassful of water three times a 
day. 

173. FOR NEURALGIA, &C. 

^ Tincturae aconiti min. xx. 

Spiritus aatheris fl. 3 jv. 

Mistura guaiaci ad. fl. 5 viij. M. 

S. One table spoonful every four hours. 



Prescriptions. 355 

174. FOR NERVOUS DEPRESSION WITH CONSTIPATION. 

1;* Spiritus ammonia 4 aromatic fl. 3 iv. 

Extracti cinchona ilava liquid] fl. 3 jss. 

Tinct. rhei fl. 3 jv. 

Infusi rhei ad. fl. 3 viij. M. 

S. Two table spoonfuls three times daily. 

175. ACID MIXTURE. 

1} Acidi sulphurici aromatici fl. 3 ij. 

Syrup aurantii. fl. 1 j. 

Tincturi cinchona composita fl. 3 vj. 

Infusi cinchona flava fl. § viij. M. 

S. One table spoonful before each meal in depressing disor- 
ders ; if there is hemorrhage, give larger doses. 

176. FOR LEUCORRHOZA. 
^ Water, one pint ; sulphate of magnesia (epsom salts), as 
much as the water will dissolve ; sulphate of iron, one drachm. 
Mix and add aromatic sulphuric acid, one fluid drachm. Dose, a 
table spoonful or a sufficient quantity to relax the bowels. 

T 77. FOR ERYSIPELAS. 

Vf, Spiritus etheris nitrici f. § ij. 

Tinct. Ferri chloridi 3 ij. 

Quinia sulphatis grs. xvj. M. 

S. A teaspoonful every three hours after the action of a 
cathartic. 

178. AROMATIC INFUSION IN DYSENTERY. 
Errata. On page 164 for (F. 178, 179) read (F. 153, 154.) 

^ Bruised calamus root 1 iij. 

Coriander seed 3 j. 

Black pepper . . . '. § ss. 

Water Oj. 

Boil to twelve ounces and cool. S. Dose for an adult, an 
ounce, three times daily ; for a child, one to three teaspoonfuls. 
Sweeten if preferred. 

179. INCONTINENCE OF URINE. 

1? Tinct. belladonna 3 ss. 

Tinct. ignatia amara 3 ss. 

Tinct. cantharides 3 ss. 

Tinct. cinchonia comp 3 jv. M. 

Sig. One teaspoonful in water three times a day. 



356 Mother, Nurse and Infant. 

180. hop bitters. 

3 Tinct. of Hops f . 1 ss. 

Tinct. of buchu . ... f. 3 iij. 

Tinct. of senega f . 5 iij. , 

Podophyllin, dissolved in spts. of wine § ss. gr. j. 

Tincture of cochinael gtt. xx. 

Distilled water ad. 1 xvj. M. 

This is said to be the same as the nostrum which is sold for one 
dollar (costing only a few cents.) 

l8l. TONIC IN NEURALGIA. 

3. Cinchonidia grs. 5. 

Ferri carb grs. 10. M. 

One to be taken every four hours, and when the pain is severe 
give a little opium or Dover powder. 

182. FOR CHRONIC CHILLS. 

3 Cinch onidae 3 vj. 

Acid sulph q. s. ad. solv. 

01. piper niger 3 ss. 

01. limonis 3 j. 

Alcohol q. s. ad. solv. M. E. adde. 

Aqua q. s. ad. Oj. 

Syrup Oj. M. 

Sig. One table spoonful every four hours. 

183. FOR ST. VITUS DANCE. (CHOREA.) 

3 Zinci sulphatis gr. xxx. 

Ext. valerian (fluid) J J. 

Syrup limonis, fl. % iij. M. 

S. A half teaspoonful three times a day, gradually increasing 
the dose. 

184. TONIC AFTER SEVERE HEMORRHAGE. 

3 Tinct. ferri chloridi, 

Tinct. nucis vomicae aa. f. 3 ij. 

Spiritus etheris nitrosi f . § iij . Misce fiat mistura. 

S. Take a teaspoonful in plenty of water three times a day. 



Prescriptions. 357 

lotions, liniments, collyria, ointments, salves, &c. 

185. for scirrhous tumors. 

I? Ext. eucaliptus 2 drachms. 

Vaseline 1 ounce. 

Acid salacylic 4 drachms. Ft. Unguent. 

Apply to tumor and wear it constantly. Use also for indolent 
ulcerations where stimulation and purification is needed. 

186. TO REMOVE CLOASMA, (BROWNISH DISCOLORATIONS 

OF SKIN.) 

3 Hydrarg bichlor 8 gr. 

Boracis pulv 2 drs. 

Acidi acetic 2 oz. 

Alcohol c 2. oz. 

Aqua 4 oz. M. 

If it roughens the skin too much omit its use and apply sweet 
cream. Sig. Apply locally to the spots. Poison. 

187. SALVE FOR BURNS, &C. 

3 Yellow wax melted and strained. . f. 3 j. 

Linseed oil raw f . 3 iij. 

Tannin 3 j. 

Sub nitrate of bismuth : 3 j. Mix as follows: 

Heat the wax in a clean tin vessel, add the oil and stir till they 
are thoroughly incorporated ; then set off the fire and continue to 
stir until cold, adding first the tannin and then the bismuth. 

188. TO CURE SORE EYES. 

I? Sulph. zinc, 

Rock salt. aa. 3 j. 

White sugar 3 ij. 

Soft water 3 xij Mix and use as an eye water. 

189. LINIMENT USED IN CEREBRO SPINAL MENINGETIS. 

5 Oil sassafras 3 ss. 

Chloroform 5 ss. 

Aqua ammonia 3 ss. 

Oil cloves 3 ij. 

Tinct. camphor 3 ss. 

Alcohol, strong 3 jv. M. 

S. Apply the whole length of the spine. 



35% Mother, Nurse and Infant. 

190. for whooping cough. 

I£ Rectified oil amber, 
Tinet. opium, 
Hartshorn, 
Olive oil aa. 1 ss. M. 

S. Rub well the whole length of the spine two or three times a 
day, until there is tenderness of the skin. 

191. AMMONIAC AL GAS FOR DYSMEiNORRHCEA. 

5 Spirits of ammonia 1 j. 

Put a teaspoonful of this in a chamber and have the patient sit 
for one or two minutes over it. In cases of severe tenesmus, or 
strangury, or dysmenorrhcea, relief may be obtained in about two 
minutes if the first pungent effects of the gas can be borne. 

I92. ANODYNE LOTION. 

5 Tinct. aconite fl. drs. 12. 

Aqua ad. fl. oz. 4. Mix. 

For acute superficial pain, pruritis, hyperesthesia of the skin, 
gout, &c. 

I93. COOLING LOTION FOR INFLAMED EYES. 

5 Pulv. borax i ounce. 

Aqua camphor 1 ounce. 

Aqua cherry laurel q. s.4 ounces. M. 

S. Drop in the eyes ad. lib. A good vehicle for the addition 
of one or two grains atropia sulphate when indicated. 

194. ANAL TROUBLES. 

3 Stramonium ung 1 ounce. 

Extract conium i drachm. 

Soda? salicyl 10 grains. M. 

Sig. Use quite within the anal folds once or twice a day. 

195. LOTION FOR PRURITIS ANI. 

5 Soda bibor 3 ij. 

Morphia muriat gr. xvj . 

Acid hydrocyan. dil 3 ss. 

Glycerine § ij. 

Aqua ad f . 5 viij. M. 

S. For external use. 



Prescriptions. 359 

196. LOTION FOR TINEA CAPITIS. (SCALD HEAD.) 

I? Acid carbolici § ss. 

Acid acetici 5 ijss. 

Aqua distilata 3 ijss. M. 

Sig. Apply pro re nata. 

197. OINTMENT FOR SKIN AFFECTIONS. 

I? Carbolic acid chrys, 

Sulphate soda aa. 3j. 

Sulphur sublim 3 j • 

Adipis 1 j. M. 

S. Apply two or three times a day. This is effectual for scald 
head, aud either with or without the sulphur is good for the erup- 
tion of poison oak, foul ulcers, &c. 

198. FOR SORE NIPPLES. 

3 Aqua rosa?, 

Glycerinae aa. 3 ij. 

Acid tanica 3 ij. ft. lotion. 

Soak lint in the solution and apply to the nipples. 

199. TURPENTINE LINIMENT. 

3 Olei terebinthanae § ij. 

Olei olivarum f ij. 

Tinct. camphora3 J j. 

Aqua ammonia 3 j. M. Fiat Linamentum. 

200. A GOOD LINIMENT. 

3 Oil lavendar § ss. 

Alcohol , I jv. M. Digest then add. 

Sulph. ether \ iij. 

Laudanum 3 ij. M. Apply externally. 

20I. BELLADONNA AND OPIUM. 
Errata. On page 88 for (201, 202) read (172, 173.) 

I? Extract belladonna, 

Extract opium aa. 3 j 

Laurel water 3 jv. M. 

To be painted over painful or inflamed parts. A sheet of tissue 
paper may be laid over this, and then a hot fomentation. 



360 Mother, Nurse and Infant. 

202. ointment for mammary abscess. 

B Unguentum tabaci flj. 

Pulv. camph 3 ij. 

Ext. belladon 3 jss. M. ft. ung. 

203. FOR PAIN. 

3- Sweet oil, 

Laudanum aa. 3 ij • 

Rub on the affected parts. 

204. BALSAM FOR WOUNDS. 

ty Balsam fir, 

True Venice turpentine, 

Oil of almonds aa. % ij. 

Add carbolic acid 3 ss. , previously dissolved in warm glycerine 
5 ij. Apply with a camel hair brush, having previously cleansed 
the wound with very warm water. 

205. FOR BOILS. 

5 Tr. arnica flowers . .' 3 j. 

Tannic acid 3 ss. 

Gum Arabic pulv 3 ss. M. 

Let the inflamed surface and all around it be painted with the 
medicine every fifteen minutes. It should be used as soon as 
prepared. 

206. FOR HEMORRHOIDS. (PILES.) 

5 Powdered opium grs. xxx. 

Tannin 3 j. 

Carbolic acid .gtt. xv. 

Oil of tobacco gtt. x. 

Sol. of sub acetate of lead . . gtt. xx. 

Vaseline § j. Mix 'intimately. 

Apply at night and morning. 

207. FOR TENDER NIPPLES. 

5 Sulphate zinc gr. j. 

Cologne water 3 j. M. 

208. Fid. ext. pinus canadenses may be used topically for ten- 
der nipples. 



FORMUl 361 

209. PILES OINTMENT- 

B Acidi tannici gr. xx. 

Morph. sulphatis gr. v. 

Ext. belladonna-, 

Ext. strammonii aa. I ij. 

Ungt. petrolei 3 ij . M. 

After bathing and cleansing, rub well on the parts once or 
twice a day. 

2IO. FOR SORE EYES. 

5 Ferri sulphas exsiccata grs. vj . 

Rain water § jv. M. 

S. Use as a colly ria. (Eye water.) 

2 11. FOR OPTHALMIA. 

1? Sulph. zinc grs. ij. 

Sulph. morphia gr. j. 

Glycerine 3 jv. 

Rose water 3 xij. M. 

S. For eye water. 

212. CHAFINGS. 

3 Finely pulverized native carbonate of zinc 3 j. 

starch §ij. M. 

To be dusted on the parts. 
1 

213. FOR ENLARGED TONSILS." 

5 Zinci sulphatis gr. xx. 

Syrupi raori fl. 3 j v. 

Glycerina fl. 3 j . 

Inf usi krameria ad. fl. 3 viij. Mix. 

S. Use as a gargle. 

214. FOR BURNS. 

5 Beeswax melted and strained 3 j. 

Flaxseed oil and sweet oil 3 ij. 

Tannic acid 3 j. 

Mix as in formula 187, and after adding the tannin, add 6 or 8 
drops of carbolic acid to the ounce. 



362 Mother, Nurse and Infant. 

215. astringent collyria. 

5 Zinci sulphatis gr. jv. 

Aluminis exsiccata gr. j v. 

Tinct. arnica min. x. 

Aqua distilata f. I j. M. 

2l6. FOR TETTER AND RINGWORM. 

^ Borax 3 ss. 

Tar water I ij . M. 

217. FOR PRURITIS OF VULVA. 

5 Borax 3 ij. 

Morphine grs. jv. 

Tar water f. § vij. M. 

Sig. Apply three times a day to the affected parts by means of 
a sponge, &c. First wash with warm water and soap, and dry be- 
fore applying the lotion. 

2l8. DANDRUFF LOTION. 

3 Tinct. of cantharides 3 ij. 

Glycerine § ij. 

Rose water § iij. M, 

219. SULPHATE OF IRON IN ERYSIPELAS. 

5 Ferri sulphas pulverized § j. 

Aqua Oss. 

Apply to affected cuticle with a cotton cloth well wetted in the 
solution every thirty minutes till the inflamed part is restored. 

220. PRURIGO VULVA. 

^ Soda bicarb 3 ss. 

Morph sulph gr. vj. 

Rose water % viij. M 

S. Apply locally. 

221. MAMMARY SWELLINGS. 

Ij[ Gum camphor § j. 

Sulph. ether, 

Tinct. opii aa. 1 ij. 

Aqua Oj . 

Dissolve the camphor in the ether, then add the opium and the 
water. Wet linen or cotton cloths and keep applied to the breasts. 



Formula. 363 

222. FOR A BLACKENED EYE. 

\j Muriate of ammonia I i,j. 

Water, 

Vinegar aa. 1 ij. 

First foment the part with hot water if there is much pain, then 
keep the contusion wet with the lotion. 

223. CHLORAL LINIMENT. 

8 Chloral hydrat 3 j. 

Liniment saponis f . J jv. M. 

Sig. For external use. Do not apply so as to cause much 
soreness. 

224. barber's itch. 

3 Hydrarg. ammoniat 10 grains. 

Bismuth, subnit 1 drachm. 

Liq. carbonis deterg 1 drachm. 

Lanolin 6 drachms. M. 

Sig. To be applied night and morning. 

225. COMEDONES. 

^ Sulphuric ether 8 drachms. 

Ammonia carbonate 1 drachm. 

Boracic acid 20 grains. 

Water, to make 16 drachms. M. 

Sig. Apply twice a day. 

226. OINTMENT FOR FRECKLES. 

^ Subnitrate of Bismuth 2 drachms. 

Simple ointment 2 ounces. 

Apply to the skin at night and remove in the morning with a 
little cold cream previous to washing. 

227. CHILBLAINS. 

B Acidi carbolici 1 drachm. 

Tinct. iodini 2 drachms. 

Acidi Tannici. ...... 1 drachm. 

Cerat simp 4 ounces. Misce bene ut ft. ungt. 

Sig. Apply two or three times a day. 

Errata. On page 166 for (F. 234) read (F. 201.) 



GLOSSARY. 



Abdomen. The belly ; the portion of trunk between the diaphragm 

and pelvis. 
Abnormal. Unnatural ; out of the usual rule or order. 
Abortion. Premature expulsion of the foetus. 
Abrasion. A breaking or rubbing off. 
Abscess. A collection of pus or matter. 
Acapuncture. To insert needles into the skin or flesh. 
Accoucheur. A skillful man midwife. 
Acetated. Combined with acetic acid. 
Acetabulum. The cotyloid cavity that receives the head of the 

thigh bone. 
Acid. A substance that can combine chemically with alkalies and 

alkaline oxides. 
Acini. Small granular masses. 
Actual Cautery. Cauterization by red hot iron. 
Acute, Sharp. An acute disease, has rapid progress and short 

duration. 
Adhesion. A sticking or growing together. 
Adipose. Fatty. 

Adjuvants. Medicines which assist the action of other medicines. 
^Etiology. The science of causes. 
Ala. A wing. 

Ala Nasi. The cartilaginous sides of the nose which move dur- 
ing difficult breathing. 
Album anoid. Resembling albumen. 
Albuminaria. The presence of albumen in the urine. A kidney 

disease. 
Alkalies. Substances that have the power of forming salts with 

acids. 
Alimentary Canal. The passage from the mouth to the anus. 
Alterative. A medicine that has power to gradually change or 

improve a disease. 
Alveoli. The bony sockets of the teeth. 
Amenorrhea. A suspension or absence of the menses. 
Anaemia. A lack of red particles in the blood ; bloodlessness. 
Anal. Relating to the anus or rectum. 
Anasarca. Dropsy of the celular tissue. 

364 



Glossary 365 

Anesthetic. Capable of producing insensibility. 

Angina. An inflammation of the throat. 

Antacid. A remedy against acidity. 

Anterior. In front, or placed before. 

Anthelmintic. A remedy against worms, destroying or expell- 
ing them. 

Antiflexion. Bending forwards. 

Antilithics. Substances that prevent the formation of calculi. 

Antiphlogistics. Such medicines as reduce an inflammatory 
habit. 

Antiseptic Preventing or resisting putrefaction. 

Antispasmodics. Such medicines as reduce spasms. 

Antiversion. Turning forwards. 

Anus. The opening at the inferior extremity of the rectum. 

Aorta. The great artery of the body, going from the heart. 

Aperient, Opening. Mildly purgative. 

Aphonia. Loss of voice. 

Apth^e. Small white ulcers of the mucous membrane. 

Apophysis. A bony process ; a prominence on the bone. 

Aqua. Water. 

Areola. A circle around the nipple. 

Areolar tissue. The tissue that connects various compound 
parts of the body. 

Articulation. The joining or union of bones. 

Artery. A vessel carrying blood from the heart. 

Ascarides. Pin worms. 

Ascites. Abdominal dropsy. 

Asphyxia. Apparent death \ suspended animation. 

Assimulation. The process by which nutriment is converted in- 
to the substance of the body. 

Asthenia. Want of strength ; exhaustion ; debility. 

Astringent. Having the power of contracting organic textures. 

Atrophy. Wasting. 

Auscultation. Listening, observing the sounds in the thorax, &c. 

Autopsy. A post mortem examination. 

Axilla. The arm pit. 

Axis. A line passing through the center of a body. 

Bacteria. A kind of microscopic organism. 

Ballottement The falling back of the displaced foetus. 

Basis. That part upon which anything rests. 

Benign. Of a mild character. 

Bile. The secretion of the liver ; the gall. 

Biology. The science of life in general. 

Bistoury A small narrow bladed knife used in surgery. 

Blastoderm. The membrane enclosing the yolk of the ovum. 

Bougies. An instrument for dilating mucous canals. 

Bronchi. The branches from the windpipe leading to the lungs; 



366 Mother, Nurse and Infant. 

Bulientis. Boiling. 

Bulemia. Abnormal appetite. 

Cachexia. A generally depraved condition of the system ; a con- 
stitutional tendency 

Cesarean Section. The operation of removing a foetus from 
the womb through the abdomen. 

Calculus. A stone in the bladder or some part of the body. 

Canula. A small tubular instrument. 

Capillaries The smallest division of blood vessels. 

Capilary. Hairlike ; small. 

Capsicum. The red pepper. 

Capsule. A membranous sac ; a gelatinous envelope in which 
medicine is taken. 

Carbonic. Pertaining to carbon or charcoal. 

Carcinoma. A cancer. 

Cardiac. Pertainirg to the heart. 

Cardiac orifice. The upper or left orifice of the stomach. 

Caries. Ulceration of the bone or teeth. 

Carminative. A medicine which tends to expel flatus. 

Cartilage. Gristle, a substance softer than bone. 

Catamenia, Menstrual discharges. 

Cataplasm. A poultice. 

Catarrh. A discharge of secretion from a mucous membrane. 

Cathartics. Medicines causing discharges from the bowels. 

Catheter. A tubular instrument for introduction into the urethra. 

Caustic An escharatic ; a burning application. 

Celular Structure. A tissue composed of minute cells. 

Celulitis Inflammation of celular or connective tissue. 

Cephalalgia. Pain in the head. 

Cerebellum. The lesser brain ; the posterior portion of brain. 

Cerebral. Relating to the brain. 

Cervix. The neck. 

Chalybeates. A liquor or medicine containing iron. 

Charta. A paper or powder. 

Chest. The body from the neck to the abdomen. 

Chirurgeri. Surgery. 

Cholagogue. Medicine increasing the flow of bile. 

Chloasma. Liver spots ; brownish discolorations of the skin. 

Chol^mia. Bile existing in the blood. 

Cholesterine. A fatty substance. 

Chorea. St. Vitus dance ; a disease. 

Chorian. An envelope of the ovum. 

Chronic. Of long duration. 

Chyle. A milky fluid made from chyme. 

Chyme. The pulp into which food is changed in the stomach. 

Cicatrix. A scar remaining after a wound is heaied. 

Cilia. Hairlike appendages. 



Glossary. 367 

Clinical. At the bedside ; pertaining to a bed. 

Clitoris. A little erectile tubercle at the front part of the mlva. 

Erratum. On gage 66 sixth line from the bottom, forg. vagina, read g. clitoris. 

Clonic. Contracting and relaxing. 

Clyster. An enema ; an injection into the bowels. 

Coagulum. A clot. 

Coaptation. Fitting together properly. 

Coccyx, Oscoccygis ; a small bone at the lower end of the sacrum. 

Collapse A sudden failing of the vital powers. 

Colliquative. Causing rapid exhaustion. 

Collyrium. An eye water. 

Colostrum. The first milk secreted after delivery. 

Colon. A portion of the large intestines. 

Coma. A profound sleep \ lethargy. 

Commissure. A point of union between two parts. 

Compound Fracture. One which communicates with the surface ; 

a fracture where the bone has protruded through the skin. 
Condyle. A protuberance on a bone. 
Confluent. Blending ; running together. 
Congenital. Dating from birth. 

Congestion. An unnatural fullness or accumulation of blood. 
Conjunctiva. The membrane covering the eyeball and lining 

the lid. 
Contagion. The transmitting of disease by contact. 
Continuity. An uninterrupted connection. 
Contra Indication. An indication against certain treatment. 
Contusion. Bruise. 

Convalescence. A period of regaining of health. 
Convulsions. Involuntary contractions of muscular parts. 
Copulation. Joining together y coition. 
Comedones. Black spots on the face. 
Coronal. Belonging to the crown or top of the head. 
Cortex. The peel ; bark. 

Cornea. The transparent membrane of the front part of the eye. 
Coryza. An acute catarrh \ the snuffles. 
Counter Irritation. Irritation excited in one part of the body 

to relieve another part. 
Cranium. The skull ; the brainpan. 
Crassamentum. Clot ; the thick part of the blood. 
Crepitus. Creaking or grating sound. 
Creta. Chalk. 

Crisis. The turning point or change of a disease. 
Cumulative. Increasing by successive additions ; augmenting. 
Cutaneous. Belonging to the skin. 
Cuticle. The scarf skin ; epidermis. 
Cyanozed. Made blue ; blue jaundice. 
Cystitis. Inflammation of the bladder. 



$68 Mother, Nurse and Infant. 

Cystocele. Descent of the bladder. 

Deciuua. Afterbirth membranes. 

Decoction. To prepare by boiling \ the results of such boiling. 

Decomposition. Separation of a body into its component parts. 

Demulcent. Of a bland, mucilaginous nature. 

Dentition. Teething. 

Deodorant. Destroying odors. 

Depurating. Cleansing from impurities. 

Dens. A tooth. 

Desquamation. A scaling of the cuticle. 

Determination. Unusual flow to any part. 

Dexter. The right. 

Dia. In a day. 

Diagnosis. Determining or distinguishing one disease from an- 
other. 

Diaphoretic A medicine which excites perspiration ; sweating. 

Diastole. The dilatation of the heart on entrance of the blood. 

Diathesis. A peculiar bodily constitution or predisposition. 

Dietetics The branch of medical art that relates to food. 

Digestton. Conversion of food into chyme and chyle 

Digital Examination. Examination by the finger, or by touch. 

Dilatation. Dilation ; expansion ; enlarging. 

Diluents. Medicines or fluids that increase the fluidity of the 
blood. 

Disinfectants. Substances that destroy septic germs. 

Dislocation. Displacement ; out of joint. 

Distal. Farthest from the heart. 

Diuresis. An unusual secretion of urine. 

Diuretics. Medicines that produce an increased flow of urine. 

Dorsal. Pertaining to the back. 

Douche. A column or current of water. 

Duct. A tube or canal which conducts a fluid. 

Duodenum. The part of the intestines next the stomach. 

Dyspncea. A difficulty of breathing. 

Dysuria. Difficult, painful, and burning urination. 

Ecchymosis. An effusion of blood into the celular structures. 

Ecclampsia. Puerperal convulsions. 

Eczema. An eruption of minute vesicles upon the skin. 

Edema. Swelling from inflammation of the celular structure. 

Effervesce. To foam from the escape of gas. 

Effluvia. Exhalation from putrescent matter. 

Effusion. The escape of a fluid from out of its natural vessels. 

Electuary. A medicinal confection. 

Embolus. A clot or some plug obstructing a blood vessel. 

Embryo. The foetus in its early stage of developement. 

Emmenagogue. Promoting the menstrual discharge. 

Emmolients. Substances that soften the animal fibre. 



Glossary. 369 

Emphysema. Air escaped into the celular tissue. 

Emulsion. A mixture of oil and water with some, ol her substance 

Endermic. Through the skin. 

Enema. An injection thrown into the rectum. 

Enteric Fever. Typhoid fever ; intestinal fever. 

Epidemic. Prevalent among the people. 

Epidermis. The scarf skin ; outer layer of the skin. 

Epiglottis. The cartilage that shuts over the windpipe in swal- 
lowing. 

Epigastrium. The region of the stomach. 

Epilepsy. Falling sickness. 

Epiphysis. A union of bone by cartilage. 

Epithelium. A layer of minute cells covering a membrane 
superficially. 

Epispastics. Substances which cause a blister. 

Errhines. Substances which cause sneezing. 

Eructation. Raising or belching gas from the stomach. 

Erythema. A skin disease with rose colored patches. 

Eschar. The dead part, killed by caustic or mortification. 

Escharotic A substance that burns or destroys animal tissue. 

Etherization. The state of the system under the influence of 
ether. 

Exanthemata. The eruptive or breaking out fevers. 

Excoriation A wearing off or abrasion of the skin. 

Exfoliate. The act of throwing off of dead bone in scales. 

Expectant. Waiting for the efforts of nature. 

Extend. To stretch • to pull out. 

Exiravisation. The effusion of the contents of vessels into the 
surrounding tissues. 

Extr* uterine. Outside the uterine walls. 

Faeces. Excrement ; evacuations from the bowels. 

Fallopian Tubes. Two ducts or tubes floating in the abdomen. 

Fascia. Fibrous membrane covering muscles. 

Febrifuge. Sedative ; assuaging fever. 

Femur. The thigh bone. 

Fibre. An organic filament or thread. 

Filament. A thread-like appendage. 

Fissure. A deep, narrow depression. 

Flatulence. Afflicted with gas in the alimentary canal. 

Flexion. The act of bending. 

Fluctuation. The undulation of fluid when pressed. 

Fcetus. The young viviperous animal in the womb. 

Follicle. A small secreting sac 

Fomentations. The application of hot cloths wet with hot water 
or medicated liquors. 

Forearm. The part of the upper extremity between the elbow 
and hand. 



37° Mother, Nurse and Infant. 

Formication. A sensation like that of the creeping of ants. 

Formula. Prescriptions ; given forms. 

Fossa. A depression in a bone. 

Frenum. A bridle ; a binding or restraining membrane. 

Fundus. The larger part of a cone shaped organ. 

Funis. The umbilical cord \ the naval string 

Furuncle A boil. 

Gall-stones. Concretions formed from the bile. 

Ganglion. An enlargement in the course of- a nerve. 

Gangrene. Partial death ; mortification. 

Gargles. Solutions applied to the throat. 

Gastric Percaining to the stomach. 

Genital. Pertaining to generation. 

Germ. An undeveloped point of growth. 

Gestation. The period of pregnancy. 

Ginglymoid. Hinge-like. 

Globus. A globe or ball 

Globus Hysterious. A sensation in the throat said to be like a 

ball. 
Glottis The opening into the windpipe. 

Gramme. The French unit of weight ; a little over fifteen grains. 
Granulations. Small red elevations looking like grains. 
Gutta, A drop. 

Gynecology. The science of the diseases of women. 
Heartburn. A hot sensation in the throat or stomach. 
Hematemesis. Vomiting of blood. 
Hemoptysis. Raising blood from the lungs. 
Hemorrhage. A flow of blood. 
Hemostatic An agent to stop bleeding. 
Hematosis. Sanguification \ furnishing blood. 
Hemicrania. Pain in one side of the head. 
Hemephlegia. Paralysis of a lateral half of the body. 
Hepatic Pertaining to the liver. 
Hernia. A protrusion of a part that has escaped from its natural 

cavity. 
Homogeneous. Consisting of similar elements or parts. 
Hydrocyanic Acid. Prussic acid. 
Hydatids. A mass of watery vesicles. 
Hydrargyrum. Mercury. 
Hydrocephalus. Dropsy of the brain. 
Hydrops. Dropsy. 

Hygiene. Science which treats of the preservation of the health. 
Hymen. The virginal membrane at the orifice of the vagina. 
Hyperemia. An excess of blood in an organ. 
Hyperesthesia. Exalted sensibility. 
Hypertrophy. Augmented bulk ; enlargement. 
Hypnotic Sleep producing ; soporific. 



Glossary. 371 

Hypochobideium. The region under the floating ribs. 
Hypogastrium. The lower pari of the abdomen, near the pubis. 
Ichor. Thin, watery, and acrid discharge. 
Icterus. Jaundice. 

Idiopathic. Primarily affecting ; not secondary or symptomatic. 
Idiosyncracy. Peculiarity of constitution or susceptibility. 
Ilium. The upper part of the hip or haunch bone. 
Illeum. The lower two-fifths of the small intestines. 
Impacted. Wedged in or driven close. 
Imperforate. Having no opening. 
Inanition. Exhaustion from want of food. 
Incompatible. Cannot be properly employed together. 
Incontinence. Inability to hold. 
Incisor. A fore or front tooth. 

Incubation. Hatching ; the maturing of contagious virus. 
Index Finger. The fore finger. 
' Induration. The act of hardening. 
Infection. The communication of virus. 
Inferior. The lower of two parts. 
Infusion. 1st. The steeping of a substance in a fluid ; 2d. The 

liquor resulting from the steeping of a substance in a fluid. 
Inguinal. Pertaining to the groin. 

Inhalations. Gas or vapor to be inspired into the lungs. 
Innominata. Nameless. 
Inspiration. Breathing in \ inhalation. 
Intercostal. Between the ribs. 

Integument. The skin ; that which covers the muscles. 
Inunction. Annointing ; rubbing in an ointment. 
Involution. The reducing of a part to its natural condition. 
Irritation. Increase of vital movement and sensibility. 
Ischium. The inferior part of the os innominatum. 
Labial. Relating or belonging to the lips. 
Labia majora. Two cutaneous folds that bound the opening of 

the vulva externally. 
Laceration. A tearing ; a breach made by rending or tearing. 
Lactation. Suckling ; the period of giving suck. 
Lacteals. The chyliferous vessels ; conveying chyle. 
Lamina. Layers. 

Laperotomy. Opening the bowels by an incision. 
Larynx. The top of the windpipe \ the cavity which contains 

the vocal ligaments. 
Latent. Concealed ; not apparent. 
Lateral. Towards the side. 
Laxatives. Medicines which render the bow T els more relaxed 

than usual. 
Leech. A cotyloid worm used for the local abstraction of blood . 
Lesion. A morbid change in the texture of an organ. 



37 2 Mother, Nurse and Infant. 

Leucorrhcea. A whitish discharge from the vagina ; the whites. 

Ligament, A fibrous band. 

Ligate. To tie ; to secure with a string or band. 

Ligature. A cord or string. 

Liquor Amii. The fluid in which the foetus is developed. 

Liter A French measure ; 2.113 pints. 

Litmus A vegetable dye ; it is turned red with acids. 

Lobe. A division, or projection of an organ. 

Lochia. Evacuations from the vagina following childbirth. 

Loins. The lateral parts of the lumbar region. 

Lumbar. Pertaining to the reins or loins. 

Luxation. Dislocation, or putting out of joint. 

Ly.mph. The colorless fluid contained in lymphatics, &c. 

Lymphatics. Lymph ducts ; certain vein-like vessels. ' 

Maceration. The act of softening or soaking a thing. 

Malaria. Noxious air from decomposed matter. 

Mammary. Pertaining to the breasts. 

Manipulation Handling skilfully. 

Marasmus. A wasting of flesh ; a tuberculous disease of the 

mesenteric glands. 
Massage. Kneading and softening of the muscles, &c 
Meatus. A passage larger than a duct ; a channel. 
Meconium. The first fceces of an infant. 
Median line. An ideal line dividing the body longitudinally. 
Medulla oblongata. The upper or cranial portion of the spinal 

cord. 
Meningitis. Inflammation of the meninges or membranes of the 

brain. 
Menorrhagia. Profuse menstruation. 
Mesentery. A portion of the peritoneum attached to the small 

intestines. 
Metastasis. A sudden removing of disease from one part to 

another. 
Metritis. Inflammation of the womb. 
Miasm. Infection floating in the air. 

Micturation. The act of urinating, or evacuating the bladder. 
Minim. The smallest liquid measure ; a drop. 
Monad. The simplest kind of minute animalcuhe. 
Mucus. A viscid fluid secreted by a mucous membrane. 
Multipara. A woman who has had two children or more. 
N^evus. A birth mark. 
Narcotic Producing sleep and stupor. 
Nares. The passage through the nose ; the nostril. 
Nates. The seat ; the buttocks. 
Necrosis. Death of the bone. 
Neuralgia. Painful affection of the nerves. 
Neurilemma. The sheath investing a nerve. 



( rLOSSARY. ^73 

Normal. Regular ) natural ; as it oughl to be. 

NvMriu:. The labia interna ; two lateral folds <»f mucous mem- 
brane within the labia externa. 

Obstetrics. Midwifery. 

Obturator foramen. An opening between the pubic and ischi- 
atic arches closed by a membranous ligament. 

Occiput. The hinder part of the skull or head. 

Odontalgia. Toothache. 

(Edema. Swelling from the presence of serum in the areolar tissue. 

(Esophagus. The gullet. 

Officinal. Authorized by the Pharmacopoeia. 

Omentum. The caul ; a peritoneal fold covering the bowels. 

Onychia. A small abscess at the side of the finger nail. 

Opthalmia. Inflammation of eyes. 

Opthalmia Xeotorum. Inflammation of the eyes of new born 
children. 

Optic. Relating to the vision. 

Orbit. The bony cavity containing the eye. 

Orthopncea. Difficulty of breathing, especially on lying down. 

Os. 1st mouth, 2d bone. 

Osmosis. The passage of a fluid through a porous membrane. 

Os Sacrum. The posterior bone of the pelvis. 

Ossification. Conversion into bone. 

Os Uteri. The mouth of the uterus ; the os tinea?. 

Oviduct. A duct in the Fallopian tube. 

Ovulation. The formation and discharge of eggs or ovules. 

Ovum. An egg ; an embryo and its membranes. 

Oxytocic. Having power to increase uterine pains. 

Oz^na. Fetid ulcer in the nose. 

Palmar. Pertaining to the interior of the hand. 

Palpation. Exploring diseased parts by touching and pressure. 

Papilla. Minute nippie shaped elevations in the skin and mucous 
membrane. 

Paraplegia. Paralysis of the lower half of the body. 

Parenchyma. The mass or principal part of organs like the lungs 
or liver. 

Parietal. Relating to the walls. 

Paroxysm. An exacerbation of severity, in a disorder. 

Parturition. Delivery ; the act of bringing forth. 

Pathology. The science which treats of the nature of disease. 

Pectoral. Pertaining to the chest or breast. 

Pediluvium A foot bath. 

Pelvis The bony structure of the lower extremity of the body. 

Percussion. The act of striking on a body to elicit sounds. 

Perinneum. The space between the tuberosities of the ischium, 
the anus, and the genitals. 

Peristaltic Vermicular or worm like. 



374 Mother, Nurse and Infant. 

Peritoneum. A serous membrane lining the abdominal cavity. 

Pertussis. Whooping cough. 

Pessary. An instrument to support the uterus when introduced 
into the vagina. 

Petechia. Spots which appear on the skin in malignent fever. 

Pharmacopceia. A treatise describing the preparation of all 
kinds of medicine. 

Pharynx. The upper part of the cesophagas. 

Phthisis. Consumption. 

Physiology. The science of the properties and functions of liv- 
ing beings. 

Placenta. The after birth. 

Plasma. The colorless fluid of the blood. 

Plethora. Overfullness of blood ; repletion. 

Pleura. The serous membrane covering the lungs 

Pleuritis. Pleurisy. 

Pneumogastric. Belonging to the lungs and stomach ; the eighth 
pair of nerves. 

Post Mortem. After death. 

Presentation. The part that presents. 

Primapara. A woman who bears her first child. 

Process. A projecting part of bones. 

Prognosis. A prediction as to the course and event of a disease. 

Prolapse. A falling down or falling out of a part. 

Prophylactic A preventive. 

Proximal. Nearest the heart. 

Pruritis Itching. 

PuERPERaL. Pertaining to childbirth. 

Pubis. The anterior part of the bony pelvis. 

Pulmonary. Pertaining to the lungs. 

Purgative. Cathartic. 

Purulent. Having the character of pus or matter. 

Pus, The creamy liquid produced by suppuration. 

Pustule. Elevations of the skin containing pus. 

Pyrexia. Fever ; the febrile condition. 

Pyrosis. Water brash. 

Quarantine. Inhibition of intercourse ; isolation. 

Quartan. Kecurring every fourth day. 

Quickening. The first motion of the foetus felt by the mother. 

Rales. Sounds produced in the lungs when there is mucus in 
the air passages. 

Ramus. A branch. 

Rectum. The terminal part of the large intestines. 

Reduction. The restoring of displaced parts. 

Refrigerant. Cooling medicines which lessen the heat of the 
body. 

Regimen. The svstematic use of the necessaries of life. 



Glossary. 375 

Remission. Temporary abatement of symptoms. 
Renal. Pertaining to the kidneys. 

Resection. Taking out a portion of bone. 

Resolution. Gradual subsidence of a disease. 

Retroflexion. Being bent over backwards. 

Retroversion. Turning or falling backwards. 

Revulsives. Appliances which remove a disease by causing a 

determination to some other part. 
Rhythm. Measured beat or movement. 
Rickets. A disease of the bones. 
Rigor A slight tremor and chilliness. 
Rigor Mortis. Stiffening of the body after death. 
Rubefacient. Making red and warm. 
Rupture. A protrusion of any of the contents of the belly 

through the parieties. 
Saccharum. Sugar. 
Sacrum. The os sacrum or os basilaire. 

Sagittal. The name of a suture that unites the paretal bones. 
Salt. A compound of an acid and a base combined chemically. 
Sanative. Curative ; sanitary. 
Sanguineous. Full of blood. 
Sanies. A thin fluid discharged from an ulcer, having some of 

the properties of pus and blood. 
Sarcoma. A tumor of a fleshy consistence. 
Sordes. An accumulation of foul secretions upon the teeth. 
Saturation. The union of one substance with another till no 

more can be received. 
Scarifications. Making small incisions. 
Sciatic Pertaining to the hip. 
Scirrhus. A hard, knotty, cancerous tumor. 
Scybala. Hard lumps of feces. 
Secretion. The vital action by which substances are separated 

from the blood. 
Secundines. The placenta and membranes ; the afterbirth. 
Sedatives. Medicines whnh diminish the action of the heart and 

nerves, and which are quieting. 
Septic Having power to promote putrefaction. 
Septicemia. Blood poisoning by putrid infection. 
SequeL/E. Morbid phenomena supervening after disease. 
Serous. Watery. 
Serum. Watery animal fluids. 
Shock. Sudden depression of the vital powers. 
Sialagogue. A medicine producing an increased flow of saliva. 
Sinapism. A mustard draught. 
Singultus. Continued hiccough. 

Sinus. An elongated cavity or abscess, having a small orifice. 
Situ. Situation. 



376 Mother, Nurse and Infant, 

Slough. A dead or mortified portion. 

Solution. The preparation made by dissolving a solid in a liquid. 

Speculum. An instrument for dilating a passage or facilitating 

an examination. 
Sphincter. A circular muscle for contracting a natural opening. 
Spinal Cord. A continuation of the brain through the vertebral 

column. 
Sporadic Occurring singly or scattered. 
Stercoraceous. Mixed with f cecal matter. 
Sternutatory. Causing sneezing. 
Stethoscope. An instrument for conveying sound from the body 

to the ear. 
Strabismus. Squinting ; an affection causing what is called 

crosseye. 
Strangury. A painful discharge of urine. 
Stricture. Contraction of a portion of a duct or tube. 
Stupe. A fomentation by means of hot cloths. 
Styptic Strongly astringent. 
Subcutaneous. Beneath the skin. 
Subjective. Pertaining to one's own consciousness. 
Subsultus. Twitching of the muscles. 
Sudamina. Small vesicles caused by profuse sweating. 
Sudoriferous. Sweating. 

Sudorifics. Medicines which produce a flow of perspiration. 
Superior. The upper of two parts. 
Suppositary. Medicine in a solid form, intended for introduction 

into the rectum, or vagina. 
Suppression. Stoppage of a discharge. 
Suppuration. The process of forming pus. 
Sutures. 1st. The seams that unite the bones of the skull. 2d. 

Stitches to hold the edges of a wound together. 
Symphasis. A peculiar kind of articulation. 
Symptoms. Signs or phenomena which accompany disease. 
Synchondrosis. Union by cartilage or gristle. 
Syncope. A fainting or swooning 
Systemic. Pertaining to the system or body generally. 
Systole. The contraction of the heart. 
Taenia. A kind of long intestinal worm \ a tape worm. 
Tampon. A plug designed to arrest hemorrhage. 
Taxis. Pressure made by the fingers t6 return a hernial tumour. 
Tendon. A cord or bundle of fibres attaching muscle to bone. 
Tenesmus. A straining at stool ] a painful sensation in the lower 

part of the rectum. 
Tent. A cylinder designed for dilating a part. 
Tertian Occurring every third day, or every forty-eight hours. 
Tetanus. A disease characterized by continuous muscular con- 
tractions ; a lockjaw. 



Glossary. 377 

Therapeutics. The application of remedies for diseases. 

Thorax. The cavity containing the lungs and heart; the chest. 

Thrombosis. The obstruction of a blood vessel by a small co- 
agulum. 

Tincture. Spirit containing medical substances in solution. 

Tone. A proper state of firmness. 

Tonic. A strengthening medicine. 

Topical. Local ; applied to a particular part. 

Tormina. Twisting, griping pains in the bowels. 

Tourniquet. An instrument for ligating a limb and making pres- 
sure on an artery. 

Transudation. Passing of a fluid through the pores or interstices. 

Traumatic. Resulting from a wound or lesion. 

Trismus. Lockjaw ; tetanus. 

Trituration. The act of reducing to a fine powder. 

Tuber Ischii. The tuberosities of the ischrum. 

Tumefaction. Enlargement ; swelling. 

Tympanitis. Flatulent distention of the belly. 

Type. Peculiar form of disease. 

Ulcer. A sore, discharging pus. 

Umbilicus. The naval. 

Unctuous. Fat \ oily. 

Urea. A nitrogenous constituent of the urine. 

Urethra. The canal that conveys the urine from the bladder out 
of the body. 

Urinometer. An instrument for obtaining the specific gravity of 
urine. 

Utero Gestation. Pregnancy. 

Uterus. The womb. 

Varicose Veins. Veins that are morbidly enlarged. 

Vascular. Full of blood vessels. 

Vein. A vessel carrying blood to the heart. 

Vena Cava. A name given to two great veins of the body. 

Vertebra. A joint of the spinal column, or back bone. 

Vertigo. Dizziness. 

Vesicants. Blistering agents 

Vesicle An elevation of the cuticle containing serum ; a 
bladder. 

Vessel. A tube or canal for fluids. 

Viable. Sufficiently developed to be capable of living. 

Vibriones. A family of minute organisms. 

Vicarious. Taking the place or office of another. 

Villi. Minute papillary elevations on a membrane. 

Virus. Organic poison ; the contagion of disease. 

Viscera. The contents of the abdomen, thorax, or head. 

Visuos. One of the internal organs. 

Vital. Pertaining to life. 



378 Mother, Nurse and Infant. 

Vivisection. The dissection of an animal while alive. 

Volatile. Capable of easily evaporating. 

Vulva. The labia externum. 

Whitlow. A felon ; an inflammation near the bone at the end of 

the finger. 
Wisdom teeth. The last of the molars to appear. 
Wound. A hurt or breach of the skin and flesh of an animal. 
Zymotic. Caused by something that acts as a ferment. 






INDEX. 



Abbreviations used in writing prescrip- 
tions, 330. 
Abdomen, pain in, 23. 
Ablutions after labor, 44. 

in pregnancy, 20. 

of the sick, 298. 
Abortion, may be accidental, 120. 

may become a habit, 120. 

premonitory symptoms, 120. 

prevention of, 122. 

in the beginning of preg- 
nancy, 120. 

treatment of, 123. 
Abscess, 166, 360. 
Accidents, 279. 
Accidents of labor, 168. 
Acidity of the stomach, 25, 336. 
Acetabulum, 57. 
Acetate of copper, poisoning by, 285. 

> . . < lead, 287. 
Acid poisons, 284, 287. 
Aconite, 265, 283. 
Etiology, 196. 

Afterbirth, function of the, 102. 
structure of, 100. 
retained, 161. 
how delivered, 131. 
Afterpains, 162, 340. 
Age suitable for marriage, 14. 

. . at which menstruation begins, 71. 
Air should be fully breathed in, 210. 
fresh, 212. 

not contaminated, 211. 
Albuminaria, 139. 
Alcohol, 283. 
Aliment, 49, 52, 225, 313. 
Alp, 218. 
Alum whey, 320. 
Amenorrhcea, 87. 
Ammonia mixture, 339. 
Ammoniacal gas for dysmenorrhoea, 358. 
Ammoniacal liniments, 226. 
Amusements, 17. 
Anasarca, 216. 
Anatomical peculiarities of the foetus, 

no. 
Anatomy of the pelvis, 55. 
Animal poisons, 288. 
Anodynes, 340, 358. 
Anodyne lotion, 358. 



Anatomy of the pelvis, 60. 

Antacids, 336. 

Antidotes, 285. 

Anthelmintics, 344. 

Anteversion of the uterus, 85, 86. 

Antiflexion of the uterus, 83. 

Antimony, poisoning by, 283. 

Antiseptic dressings, 166. 

Antiseptics, 238, 338. 

Antispasmodics, 339. 

Aperients, 343. 

Apoplexy, 281. 

Apparent death, 280, 288. 

Apple water, 316. 

Apthae, 175. 

Areola, 105. 

Arm presentations, 187. 

Aromatic spirits of ammonia, 270. 

Arrow root custard, 323. 

Arrow root, how to prepare, 322. 

Arsenic, poisoning by, 284. 

Arteries, 255. 

Art of prescribing, 326. 

Articles wanted at childbirth, 32, 

Artificial respiration, 289. 

Ascarides, 150. 

Asphyxia, 160, 288. 

Asphyxiated persons, 288. 

Asthma, 217, 220, 339. 

Astringents, 340 

Atropine as a poison, 283. 

Auscultation, 108, 140. 

Bacteria, 169. 
Ballottement, 107. 
Bandages, applying, 261. 
making, 251. 
after confinement, 41. 
Barber's itch, 363. 
Bathing, 19, 250. 

of infants, 53, 54. 
short rules for, 250. 
Baths, blanket and hot air, 249. 
cold and cool, 248. 
salt and sulphur, 250. 
sitz, 298. 

temperate and tepid, 248. 
warm and hot, 248. 
Bearing down pains, 158. 
Bedrooms, 246. 



379 



3 8o 



Index. 



Bed sores, 246. 

Reds, in confinement, 37. 

Bee stings, 303. 

Bee tea, 302. 

Beef-juice, 326. 

Beef tea, 325, 326. 

Belladonna, poisoning by, 283, 287. 

Beverages, 44. 

Bismuth, 285. 

Bites of mad dogs, 288. 

venomous snakes, 288. 
Bitters, hop, 350. 
Blackened eye, 297. 

Bladder state of, after confinement, 163. 
Bleeding from the nose, 301. 
Blisters, how dressed, 227. 

why used, 226. 
Blood root powder, 264. 
Body presentations, 187. 
Boiled flour, 40. 
Boiled rice and cocoanut, 323. 
Boils, 360. 
Bones of the foetal head, 108. 

pelvis, 56. 
Bowel complaints of children, 268. 
Bread jelly, 319, 323. 
Bread poultices, 232. 
Breast, care of, 48, 165, 166. 

gathered, 166. 
Breathing exercise, 306. 
Breech presentation, 184. 
Brim of the pelvis, 60. 
Broken bones, 257. 
Bronchitial asthma, 217. 
Bronchitis, 220. 
Broths, 248 

Brown discolorations of the skin, 357. 
Bruises, 255. 
Burns and scalds, 292, 293. 

dry, 292 

salve for, 357. 

Cantharides, poisoning by, 286. 
Carbolic acid, 273, 284. 
Carbonic acid gas, poisoning by, 288. 
Care of infant children, 170. 
Care of mother during confinement, 42, 
43, 163. 
labor, 41, 157. 
Catamenia, 70. 
Cataplasm, 233. 
Cathartics, 342. 
Catheter, introducing the, 78. 
Catherization, 78. 
Causes of disease, predisposing, 196. 

exciting, 196. 

heat and cold, 197. 

the season, 202. 
Causes of tedious labor, 142, 151, 155, 

179. 
Caustics, 344. 
Cervex uteri, 66. 
Cessation of menses, 72. 
Chafings, 171. 



Chalk mixture and hops, 336, 

Change of life, 73. 

Changing clothing, 251. 

Charcoal, 240, 299. 

Chicken broth, 325. 

Chicken tea, 324. 

Chilblains, 363. 

Children, diseases of, 217. 

Chlorate of potash, 272. 

Chlorosis, 265, 352. 

Cholera infantum, 174, 334. 

Cholera mixture, 337, 339. 

Cholera morbus, 175. 

Choosing food for infants, 307. 

Chorea, 217, 218, 356. 

Cicitrization, 256. 

Cinnamon mixture, 340. 

Circulation of blood in the foetus, no. 

Classification of medicines, 331. 

Cleanliness in cooking, 309. 

Climate, 198. 

Clinical thermometer, 276. 

Clothes on fire, 292. 

Clothing for the lying in woman, 37. 

. . pregnant woman, 19. 

. . infant, 53 

how to change, 45. 
Coccyx, 59. 
Coffee, 303, 321. 
Cold applications, 225, 235. 
Cold as a cause of disease, 197, 199. 
Cold bath, 201. 
Cold in the head, 276. 
Colds, 265. 
Cold water, 235. 
Colic, 333, 337. 
Collyrium, 236, 362. 
Coma, 281. 

Common diseases, 263, 
Compound licorice powder, 272. 
Compression of the brain, 281. 
Conception, nature of, 94. 
signs of, 112. 
Concussion of the brain, 281. 
Conduct of mother after marriage, 17. 

during pregnancy, 18 
Confinement, preparations for, 32, 37. 

bed for, 37. 

dress for, 37. 
Conium, poisoning by, 383 
Constipation, 23. 

Contagion, caused by germs, 237. 
Contagious diseases, 237. 
Contused wounds, 255. 
Contusions, 255. 
Convalescence, 163. 
Convulsions, infantile, 290, 290, 302. 

purperal, 194. 
Cooker)' for the sick, 309 

.. young children, 309. 
Cool bath, 248. 

Cooling lotion for inflamed eyes, 358. 
Corns, 303. 
Corn tea, 317. 






Index. 



381 



ts, 19 

Coryza, 276. 

Costh eness, 22, 171. 

Cough, 220. 

Cough SVTU] . 

Counter irritants, 225, 
Cracked nipples, 168. 
Cramps 
Cravings, 395. 

Critical pen >d of life, 73. 

Croton oil, 286. 

Croup, 266, 334. 

Cupping, dry and wet, 229. 

Cutting the gums, 274, 296. 

Cystitis, 163. 

Cystocele, 142, 346. 

Dandruff lotion, 362. 
Dead, care of, 242. 
1 >eath, 219, 242. 
Decoction of bran, 315. 

. . barley water, &c, 345. 
Deformed pelvis, 182. 
Dentition, 274. 

I )epression of spirits during suckling, 49. 
Development of the uterus in preg- 
nancy, 95. 
Developement of the fcetus in preg- 
nancy, 105, 106. 
Diabetis, 306 
Diagnosis, 217, 277. 

by palpation, 140. 
of artificial labor, 126, 138. 
of diseases in children, 217. 
of pregnancy, 112. 
by vaginal touch, 126. 
Diameter of the pelvis, 61. 

# . . ^ . . child's head, 107. 
Diaphoretics, 345. 
Diarrhoea prescriptions, 268, 338. 
in a child, 171, 267. 
in pregnancy, 25. • 

Dietery after labor, 44, 47. 
during suckling, 44. 
of a pregnant female, 19. 
of the young wives, 17 
Diet for infants and children, 307. 

. . the sick, 309. 
Dietetics, 30. 
Differences of pelves, 63. 
Difficult labor, 177. 
Digital examinations, 140. 
Diphtheria, 264, 263. 
Diphtheria powder, 263, 264. 
Directions for domestic medication, 262. 
Directions to the monthly nurse, 33, 43. 
things to be provided, 33. 
care of the mother ; rest, 43. 
diet, 43. 
beverages, 44. 
the lochial discharge, 44. 
ablutions, 44 
clothing, 45. 
retention of urine, 47. 



Directions mother's breasts, 47. 

care of child's food, 49, 51, 52. 
sleep, g ;. 
the naval, 53. 
clothing, 53. 
Disiases of children, 217, 
infants, 171. 

pregnancy, vomiting, 121. 
morning sickness, 21. 

Diseases of the throat, 264. 
Disinfectants, 238, 239. 
Disinfection, 241. 
I )islocations, 259. 

of elbow, 260. 
of thumb or finger, 260. 
Disorders of menstruation. 87. 
amenorrhcea, 8-. 
dymenorrhcea, 88. 
menorrhagia, 92. 
Displacements of the uterus, 76. 
Diuretics, 346. 
Domestic medication, 262. 
Domestic management of colds, 265. 
diarrhoea, 268. 
fevers, 266. 
dj'sentery, 269. 
cramp, 266. 
croup, 266. 
faintingfits, 270. 
Doses for children and adults, 327. 
Dress for labor, 37. 
Dressing the child, 40, 41. 
Dropsies, 216, 347. 
Dropsy of the head, 218, 219. 
Drowning, 288. 
Drugs, list of, 263. 
Duration of pregnancy, 124. 
Duties of a wife, 19. 

. . skilled nurse or midwife, 145. 
making examination, 156. 
how to act as midwife, 149. 
turning the child, 185. 
care of the child, 170. 
post partum hemorrhage, 160. 
adherent placenta, 161. 
after pains, 162. 
retention of urine, 162. 
Shock, 163. 
the lochia, 164. 
the milk, 165. 
care of the breasts, 165. 
convulsions, 144. 
mania, 169. 
septicemia 169. 
care of infant children, 170. 
Duties of a nurse in various circum- 
stances, 237. 
Dysentery in the infant, 171. 

. . children 220, 269, 338, 340. 
Dysmer.orrhcea, 88, 89, 91, 340. 
Dyspepsia, 270. 

E;r, foreign substance in, 293. 
Earache, 218, 219. 



3*2 



Index. 



Early treatment of disease, 221. 

Effects of the season upon health, 202. 

Effervescing lemonade, 317. 

Elbow joint, dislocation of the, 280. 

Elbow presentation, 185. 

Elm slippery, 273. 

Embryo, 103. 

Emergencies, 279. 

Emetics, 347. 

Emenagogues, 352. 

Emotion, influence of on child, 21. 

Enema apparatus, 33. 

Enema for pinworms, 350. 

Enemata, 298, 349. 

Epidemics. 238. 

Epileptical seizures, 290. 

Epistaxis. 306. 

Erect carriage, 306. 

Ergot, 155. 

Eruptive fevers, 278. 

Erysipelas 253, 362. 

Essence of beef, 326. 

Etherization, 291. 

Excessive sweating, 298. 

Exercise during pregnancy, 19, 26, 35. 

before breakfast, 22. 
Expectorants, 348. 
Extra uterine pregnancy, 94. 
Eye lotion, 357, 361, 362, 

Face presentations, 143, 183. 

Fainting, 25. 

Fainting in pregnancy, 25. 

Falling of the uterus, 76. 

Fallopian tubes, 67 

False labor pains, 34, 123. 

Father's influence, 15. 

Fecundation, 94. 

Feeding infants, 49, 307, 314. 

Febrile disorders, 220. 

Female weakness, 77. 

Fire, clothes catching, 292. 

Fissure of the anus, 218 

Fits, 290. 

Flatulence, 38. 

Flatulent colic, 333, 337. 

rlaxseed, 315. 

Flexions and versions of the womb, 75. 

Flour boiled, 322. 

Fluid aliments, 313. 

Foetal circulation, 104, no, in. 

life, 103. 
Foetus its development, 105, 103. 

size at term, 106. 
Fomentations, 231, 234, 352. 
Fontanelles, 169. 
Food, during pregnancy, 19. 

. . for a child, 50, 307. 
for convalescents, 310. 
milk and eggs, 312. 

. . rules for giving, 310. 

• - varieties of, 311. 
Foot bath, 298. 
Foreign matter in a wound, 254. 



Foreign matter in the ear, 293. 

eye, 293. 

nose, 293. 

throat, 294. 

Formulae for food, 314. 
Formulas for medicines, 332. 
Fractured ribs, 296. 
Fractures, nurses duties, 258. 
Fractures, signs of, 257, 258. 
Friction, 269. 
Fruits, 313. 
Fumigation, 241. 
Fundus of the uterus, 65. 

Gargles, 306. 
Gathered breasts, 166. 
Gelsemium, 283. 
Generation, 93, 94. 
Germ diseases, 237. 
Gestation, period of, 94, 124. 
Giving medicines, 245. 
Giving anesthetics, 291. 
Graafian vesicle, 75. 
Granulations, health}'-, 256. 
Green sickness, 237. 
Gum Arabic, 272, 315. 

Hardening infants, 201. 
nipples, 27. 
Haunch bone, 57. 
Head of the foetus, 108. 
H°ad presentations, 140. 
Headache, 219, 354. 
Health, 14. 
Health of wives, 14. 
Heartburn, 25, 336. 

in pregnancy, 24. 
Heat as a cause of disease, 197. 

. . a symptom of inflammation, 115. 
Hematuria and menorrhagia, 92, 341. 
Hemoptysis, 341. 
Hemorrhage, unavoidable, 193. 

during labor, 193, 194. 

internal, 194 

post partem, 161. 

from cuts and incisions, 

255- 
Hemorrhoids, 275, 360. 
Herb teas, 317. 
Home remedies for ague and fever, 277. 

apoplexy, 279. 

opthalmia, 275. 

bronchitis, 276. 

constipation, 275. 

diarrhoea, 268. 

dysentery, 269. 

hysteria, 278. 4 

pneumonia, 276. 

scarlet fever, 278. 

typhoid fever, 278. 
Honey, 302. 
Hop bitters, 356. 
Hot baths, 248. 
Hot foot baths, 298. 



Index. 



383 



Hot water, 297. 

How to breathe, 210. 

How to cook rice, 323. 

How to prepare arrow root, 322. 

How to use injections, 351. 

Hydrocyanic acid, poisoning by, 287. 

Hyoscyamus, 283. 

Hyperemia, 

Hysteria, 278. 

Hypnotic suppositary, 352. 

Ice, 235. 
Ice bags, 235. 
Iliac fossa, 57, 58. 
Impacked feces, 142, 151. 
Incised wounds, 254. 
Incompatible marriages, 16. 
Incontinence of urine, 355. 
Indian meal gruel, 318. 
Indigestable food, 397. 
Inefficient action of uterus, 151. 
Infant, care of, 40. 
Infant feeding, 174. 
Infection, 238. 

Inflammation, symptoms of, local heat, 
215. 
pain, 215. 
redness, 216. 
swelling, 216. 
tenderness, 214. 
general symptoms, skin, 
pulse, 223. 
terminations, resolution, 
214. 
suppuration, 
258. 
treatment of, general, 223. 
. . . . topical, 225. 

Inflammation of the breast, 165. 
Infusion of flaxseed, 315. 
Infusions, 317. 
Inhalations, 303. 
Injections, 298. 
Injections for the vagina, 351. 
Innominata, 56. 
Instructions to a woman before labor, 

26. 
Instructions to nurses, labor, 147. 

tedious labor, 151, 178. 
breech presentations, 184 
knee or foot . . 185. 
shoulder, body or head 

presentations, 141. 
face, 141. 

inefficient action of the 
uterus, 151. 
^ . . excess of liquor amnii, 

152, 179. 
powerless labor, 180. 
obstructed labor, 181. 
deformed pelvis, 182. 
adherent placenta, 161. 
placental presentation, 193 
to wife and mother, 13. 



Instructions to nurse midwife, 14^, 
156, 192. 
to the mother before la- 
bor, 26. 
Internal organs of generation, 66. 

uterus, 65. 

Fallopian tubes, 67. 

ovaries, 68. 

vagina, 68. 

ligaments of the womb, 69. 
Introducing of catheter, 78. 
Introduction, 9. 
Inversion of uterus, 168. 
Ipecac, 271. 
Irritable uterus, 350. 
Irritation, 229. 
Itchings, 298. ' 

Jaundice, 176. 
Jelly water, 316. 
Joints of the pelvis, 59. 

Knee chest position, 80. 

Labor, difficult, 177. 

directions for conducting, 39, 
149, 156. 

false, 34. 

true, symptoms of, 36. 
Lactation. 165. 
Laxatives, 343. 
Leeches, 229. 
Ler.corrhcea, 351. 
Light, effects of, 46. 
Lightning, 290. 
Lineo ilio pictinea, 60. 
Liniments, 226.^ 
Liniment used in cerebro spinal menin- 

getis, 357. 
Liquor amnii excessive, 152. 
Lister's dressing, 166. 
Little ailments, 297. 
Lochia, profuse, 165. 
scanty, 164. 
fetid, 165. 
Lochial discharge, 45, 164. 
Locked jaw, 253. 
Longings in pregnancy, 19. 
Lotion for pruritis, 362. 
Lotion for tinea capitis, 359. 
Lotions , 357. 

Mad dog bites, 288. 
Mammary abscess, 166, 362. 
Mammary inflammation, 165. 
Manner of feeding infants. 313. 
Marriage should not be at too early an 

age, 14. 
Marshall Hall's method, 289. 
Measles, 274. 

Meatus of the urethra, 64. 
Measures, 61. 
Mechanical phenomena of labor, 133. 



3^4 



Index. 



Mechanical presentations and positions, 

r 3.5- . 

how distinguished, 126. 
Meconium, 171. 
Meddlesome midwifery, 192. 
Medicines, classed, 331. 

in pregnane}', 28. 
Medicated bath, 250. 
Meningitis, 218. 
Menorrhagia symptoms and varieties 92 

treatment of, 93. 
Menses, cessation of, 73. 
Menstruation, retarded, 72. 

its disorders, 73. 
painful, 90, 91. 
profuse, 92. 
Midwifery, [40, 145. 
Milk, as food, 312. 
fever, 165. 
. . in the breasts of newborn infants, 

171; 
. . mother's influence of diet on, 172. 
porridge, 319. 
Miscarriage, cause of, 121. 

flooding in, 121, 123. 
prevention of, 122. 
treatment of, 123. 
Mismenstruation, 87. 
Mistakes in giving medicine, 245. 
Mode of administering medicine, 328. 
Morning sickness, 105. 
Morphine, poisoning by, 297. 
Mother, 19. 

Mucilage of starch, 322. 
Mumps, 274. 
Mush and milk, 320. 
Mustard plasters, 226. 
Mutton broth, 326. 
Mutton soup, 325. 

Narcotic poisons, 286. 

Narcotics, 353. 

Natural labor, 149. 

Nausea, 337. 

Naval, soreness of, 170. 

Naval string, 101. 

Naval string, dressing of, 53 

Nervous disorders, 220. 

Nervous shock, 163. 

Neuralgic dysmenorrhcea, 89. 

Night nursing, 245. 

Night sweats, 341.. 

Nipple, cracked and sore, 360. 

retracted, 41. 

to harden, 26. 
Nose bleed, 301. 
Nutricious coffee, 321. 

laxative, 321. 
Nurses, duties of, 33. 

general rules, 243. 

qualifications of. 30. 

responsibilities of, 33. 
'should be well paid, 31. 

skilled, 145. 



Nursing, rules for, 33, 

Nux vomica as a poison, 283, 287. 

Oatmeal gruel, 318. 
Observation of symptoms, 221. 
Obstructed labor, 181. 
Obturator foramen, 57.- 
Oil, 302. 

Ointment for skin affections, 359. 
Operation cases, 251. 
Opium, 224. 

for labor, 155. 

poisoning by, 287. 
Opthalmia, 391. 
Ordinary hurts, 297. 
Organs of generation, 64. 
Os coccygis, 59 
Ossa innominata, 56. 
Os sacrum, 55. 
Os tincae or os uteri, 66. 
Outlet of the pelvic canal, 62. 
Ova, 98. 

Ovarian neuralgia, 89. 353. 
Ovaries, 68, 69, 74. 
Ovum, its development, 98. 
Oyster broth, 324. 
Oysters, 312. 

Pains, 128, 129. 

Palpation for diagnosis, 140. 

Palpitation of the heart, 26, 354. 

Panada, 318, 322. 

Paralysis, 217, 218. 

Paregoric. 2c 8. 

Parotitis, or mumps, 280. 

Parturition, 123, 125. 

Passion, ill effects of during pregnancy, 

21. 
Pelvis, 55, 60, 62. 
Percussion, 106. 
Perineum, 65. 
Period of gestation, 124. 
Persons asphyxiated, 288. 
Phthisis, tubercular, 277. 
Phosphorus, poisoning by, 286. 
Physician should be selected, 28. 
Physiology of fcetal life, 109. 

of uterus and ovaries, 70. 
Physiological phenomena of labor, 126. 
Piles in pregnancy, 24, 273. 
Piles ointment, 361. 
Placenta, 100, 101. 

adherent, 131, 160. 

previa, 193. 
Placental presentations, iot, 193. 
Pleurisy, 225. 
Pneumonia, 220. 
Poached eggs, 324. 
Poisons an i their antidotes, 281, 284. 
Position of patient during parturition, 

148. 
Position of the foetus in utero, 107. 
Post partem hemorrhage, i6t. 
Potus imperialis, 321. 



Index. 



3«s 



Poultices, alum. 233. 
bread, 23a. 
• har oal, 234. 
conium, -'34. 
yeast, 253. 
P w erless labor, 1S0. 
Precocious unions, 14. 
Precussory symptoms of labor, 35, 36. 

the menses, 71. 
Pregnancy an \ confinement, 13. 

disorders incident to, 22. 139. 
duration of, 124. 
Premature infants, 54. 
labor, 120. 
Premonitory symptoms of labor, 126. 
Preparation for labor, the bed, 37. 

dress, 37. 

room 38. 

of food, 309. 
Presentation of the face, 141, 183. 

feet or knees, 185. 
head, 140. 
shoulder, 185, 187. 
side, 185, 187. 
superior extremities, 
141, 185. 
Presentation and positions, 135, 126. 
Process of generation, 93. 
Procidentia, 76. 
Profuse menstruations, 92. 
Prolapsis, 76. 
Pruritis vulva, 26. 362. 
Puberty, the age of, 71. 

the change it works, 71, 
Pubis, 58. 

Puerperal convulsions, 194. 
Puerperal mania, 169. 
Puerperal septicemia, 169. 
Pulse. The rate, 206. 

regularity, 207, 
hardness, 207. 
Pure air, 211. 
Purgatives, 342. 
Pus, 166. 
Pies, 313. 
Pyemia, 253. 

Qualities transmitted by parents, 315. 

Quickening, 116. 

Quinsy, 275. 

Quiet after confinement, 43. 

Recipes for sick cookery, 314. 

Reckoning, how to make the, 124. 

Regimen, 262, 302. 

Remedies for common use, 262. 

Remedies to prevent costiveness, 302. 

Removal of the placenta, 39. 

Reproduction, 93. 

Restorative soup for invalids, 324. 

Respiration, 209. 

a diagnostic symptom, 210. 
Retention of the urine, 47, 152, 174. 
Retroflexion of the uterus, 83. 



Rheumatism, 335, 347, 353. 

Rice gruel, 318. 

Rice cream, 319 

Rickets, 218. 219. 

Rigid os uteri, 154. 

Rigid perineum, 155. 

Rigor mortis, 242. 

Ringworm, 362. 

Rubeola, measles, 274. 

Rules in nursing, 243. 

Rules of diet for convalescents, 310. 

Rupture of the naval, 170. 

Sacrum, 55. 

S'ge tea, 316. 

Sagittal suture, 108. 

Salt water, 299, 300. 

Sanguinaria powder, 263. 

Saucepans, 310. 

Scalds. 292. 

Scarlatina or scarlet fever, 278. 

Sciatica, 335. 

Secretion of milk, 165. 

Sedatives, 224, 353. 

Septicemia, 169 

Setons, 229. 

Shock, 163. 

Show, a sign of labor, 128. 

Shower bath, 201. 

Sick headache, 270. 

Sick room, 38. 

Signs of approaching labor, 35, 127. 

Signs of death, 242. 

Signs of pregnancy, 113, 118. 

Size of the pelvis, 61. 

Size of the foetus, 106. 

head, 107. 

Skilled nursing, 145. 

Sleep during pregnancy, 21. 
position in, 21. 

Sleeping rooms, 20, 212. 

Sleeplessness, 303. 

Slight hurts and ailments, 295. 

Slippery elm bark tea, 316. 

Soda and water, 301. 

Soda mint, 338. 

Solution of chlorinated soda, 351. 
i Sore mouth, 175. 
! Sore nipples, 27, 359, 360. 

Soup, 312, 321, 324. 
I Sour stomach, 270, 336. 
j Sour milk, 311. 
I Spirit vapor bath, 249. 
: Sponge baths, 45, 249. 
i Sponges, 252. 
■ Sprains, 297. 
I Spurious labor pains, 124. 

Stays, 19. 
I Strangury, 302. 
1 Strapping, 254. 

Stupes, 231. 
I Subacute rheumatism, 353. 
j Suckling the child, 48. 
: Summer complaints, 268. 



3 86 



Index. 



Sunstroke, 280. 
Suppositories, 173, 352. 
Surgical cases, 251. 
Surgical nursing, 251. 
Sutures, sagittal, 108. 
coronal, 108. 
lambdoidal, 108. 
Sweating, excessive, 298. 
Symphasis pubis, 61. 
Symptomology, 196. 
Symptoms of disease, subjective, 204,206 
objective, 206. 
character of the 

[pain, 205. 
tenderness, 205. 
itching. 205. 
nausea, 205. 
thirst, 206. 
the pulse, 306. 
. . temperature. 

J208, 215. 
.. respiration, 

[209. 
asthma, 217 

hydrocephalus, 218, 219. 
hysteria, 278 
earache? 218. 
brain affections, 219. 
chorea, 219, 217. 
bronchitis, 220. 
sunstroke, 280. 
inflammation, 214. 
poisoning, 282. 
Syncopes fainting, 270, 281. 
Sjnrup of ipecac, 267, 271. 

Table tea, 320. 

Table of abbreviations, &c, 330. 

Tampons, 80, 81. 

Tartar whey, 317. 

Tar water, 45, 300. 

Teething, 296. 

Tedious labor, 151, 178. 

Temperature of the patient, 207. 

sick room, 213. 

baths, 248. 
how taken, 208. 
Temperaments, 16. 
Temperate bath, 248. 
Tepid baths, 248. 
Tetanus, 253. 

The first few months after marriage, 16. 
Thermometer, 276. 
Throat diseases, 264. 
Tenderness, 253 

Terminations of inflammation, 215. 
Tin, poisoning by, 285. 
Tieing the cord, 39. 
Tinea capitis or scald head, 359. 
Tincture of iodine, 228. 
Thirst, 44. 
Thrush, 175. 
Tongue, coated, 220. 
Treatment of infantile diseases, 217. 



Treatment of inflammation in emergen- 
[cies, 224. 
in the incip- 
ient stages, 223. 
by vera- 
[trium, 224. 
by aperients 

[224. 
by opium, 

[224. 
by counter 
[irritants, 225. 
by vesicants, 

[225. 
by topical 
[applications, 225. 
by liniment, 
[226. 
by mustard, 
[226. 
by blisters 
[and cupping. 227. 
by Leeches, 
[229. 
by fomenta- 
tions, 231. 
Toast, 322. 
Toast water, 316. 
Tonics, 355. 

Tonic in neuralgia, 356. 
Toothache drops, 354. 
Touch. 126. 
Turn of life, 72. 
Tuber ischii, 58. ^ 
Tubercular phthisis, 277. 
Typhoid fever, 278. 
Typhus fever, 278. 

Ulcer, gastric, 334. 
Umbilical cord, 101. 
Umbilical artery and vein, 101, 111. 
Undilatable os uteri, 154. 
Uretha, 64. 

Urinary and generative organs, 65. 
Urine, incontinence of, 355. 
retention of, 47. 
should be examined, 29. 
Uses of the pelvis, 63. 
Uterine derangements, 65. 
Uterus, description of. £ 5, 66, 67, 70. 

displacement of, 76, 

antiflexion of. 84. 

antiversion of, 85. 

retroflexion of, 83. 

retroversion of, 85, 81. 

prolapsis of, 77. 
Utero gestation, 95. 

Vagina, 68, 142. 
Vaginal cystocele, 142, 182. 
Vaginal injection 351. 
Vaginal touch, 140. 
Vapor baths. 248. 
Vegetable soup, 321. 



Indk.x. 



3»7 



Ventilation, 20, 212. 
Ventilation ot bedrooms, 213. 
Veratrium viride, 224, 265. 
Versions of the uterus, 85. 

Vesica] calculi, 142. 
Vesicants. 225, 227. 
Vinegar whey. 315. 
Vomiting, 324. 
Vomiting in pregnancy, "22. 

Warm baths, 248. 
Warm water, effects of, 250. 
Washing the child, 40. 52. 
Waters, breaking of the, 152. 
Water, cold, 44, 298. 

hot, 297. 
Water bed, 247. 



Weaning. 308. 

Wet girdle, 299. 

Wet cups, 229. 

Wet nurse, 51, 174. 

Wet pack, 248. 

Wet sheet pack, 248 

Whites or leucorrhoea, 355. 

Whooping cough, 303, 339. 

Witch hazel, 271. 

Woman, and her diseases, 75. 

Womb, 66. 

Worms, 350. 

Wounds, incised, 254. 

contused, 255. 

punclured, 256. 

poisoned, 256. 



The End. 



LIBRARY OF CONGRESS 



021 062 836 8 




MH 



